Preparations for a heart transplant often begin long before the surgery to place a transplanted heart. You may begin preparing for a heart transplant weeks or months before you receive a donor heart.
Taking the first steps
If your doctor recommends that you consider a heart transplant, you will likely be referred to a heart transplant center for an evaluation. You're also free to select a transplant center on your own. Check with your health insurance provider to see which transplant centers are covered under your insurance plan.
When evaluating a heart transplant center, consider the number of heart transplants a center performs each year and transplant recipient survival rates. You can compare transplant center statistics on the Web using a database maintained by the Scientific Registry of Transplant Recipients.
Also consider additional services provided by a transplant center. Many centers coordinate support groups, assist with travel arrangements, help you find local housing for your recovery period or direct you to organizations that can help with these concerns.
Once you decide where you would like to have your heart transplant, you'll need to have an evaluation to see if you're eligible for a transplant. The evaluation will check to see if you:
- Have a heart condition that would benefit from transplantation
- Might benefit from other less aggressive treatment options
- Are healthy enough to undergo surgery and post-transplant treatments
- Will agree to quit smoking, if you smoke
- Are willing and able to follow the medical program outlined by the transplant team
- Can emotionally handle the wait for a donor heart
- Have a supportive network of family and friends to help you during this stressful time
Waiting for a donor organ
If the transplant center medical team determines that you're a good candidate for a heart transplant, the center will register you on a waiting list. At any given time, there are about 3,000 people in the U.S. waiting for heart transplants. Unfortunately, there aren't enough hearts for every person in need, and some people die while waiting for a transplant.
While you're on the waiting list, your medical team will monitor your heart and other organs and alter your treatment as necessary. Your transplant team may temporarily remove your name from the waiting list if you develop a significant medical condition, such as a severe infection or stroke, which makes you temporarily unable to have a transplant while you recover.
If medical therapy fails to support your vital organs as you wait for a donor heart, your doctors may recommend you have a device implanted to support your heart while you wait for a donor organ. These devices are known as ventricular assist devices (VADs). The devices are also referred to as a bridge to transplantation because they gain you some time until a donor heart is available.
When a donor heart becomes available, the donor-recipient matching system considers these factors to make a match:
- Medical urgency of potential recipients
- Blood type (A, B, AB or O)
- Antibodies the recipients may have developed
- Size of the donor organ
- Time spent on the waiting list
Immediately before your transplant surgery
A heart transplant usually needs to occur within four hours of organ removal for the donor organ to remain usable. As a result, hearts are offered first to a transplant center close by, then to centers within certain distances of the donor hospital. The transplant center will provide you with a pager or cellphone to notify you when a potential donor organ is available. You must keep your cellphone or pager charged and turned on at all times.
When you're notified, you and your transplant team have a limited amount of time to consider whether to accept the donation, and you'll be expected to travel to the transplant hospital immediately after being notified of the potential donation.
As much as possible, you should make travel plans ahead of time. Some heart transplant centers provide private air transportation or other travel arrangements. Have a suitcase packed with everything you'll need for your hospital stay, as well as an extra 24-hour supply of your medications.
Jan. 27, 2015
- What is a heart transplant? National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/dci/Diseases/ht/ht_all.html. Accessed May 27, 2014.
- Mancini D, et al. Indications and contraindications for cardiac transplantation. http://www.uptodate.com/index. Accessed May 27, 2014.
- Colvin-Adams M, et al. OPTN/SRTR 2012 annual data report: heart. American Journal of Transplantation. 2013;14:113.
- Jessup M, et al. 2009 Focused update: ACCF/AHA guidelines for the diagnosis and management of heart failure in adults. Circulation. 2009;119:1977.
- What is a ventricular assist device? National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/dci/Diseases/vad/vad_all.html. Accessed May 27, 2014.
- Pham MX, et al. Prognosis after cardiac transplantation. http://www.uptodate.com/home. Accessed May 27, 2014.
- Pina IL, et al. Rehabilitation after cardiac transplantation. http://www.uptodate.com/home. Accessed May 27, 2014.
- Yip DS (expert opinion). Mayo Clinic. Jacksonville, Fla. July 10, 2014.