What Is a Heart Transplant?

A heart transplant is a significant surgery where a diseased heart is replaced with a healthy donor heart. This procedure is considered the ultimate treatment for end-stage heart failure, typically after other treatments like medications and cardiac procedures have failed. Due to the limited availability of donor hearts, not everyone qualifies for a transplant, and there are strict criteria for getting on the waiting list.

Evaluation Process

Undergoing a heart transplant involves more than just the surgical procedure. Candidates go through a thorough evaluation at a heart transplant center, including a physical exam, various blood and imaging tests, and a psychological assessment to evaluate mental and emotional health and social support. The transplant team reviews all information from medical history, clinical findings, and diagnostic tests to determine eligibility.

Waiting List

Once approved, candidates are placed on the United Network for Organ Sharing (UNOS) waiting list. During the wait, a patient’s health may deteriorate, which can lead to temporary or permanent removal from the list.

Transplant Team Support

Each transplant candidate has a dedicated team that educates the patient and their family about the entire transplant process, including preoperative protocols, surgical risks, and postoperative care.

Eligibility Criteria

Not all patients with heart failure are suitable candidates for a transplant. The evaluation process considers factors such as:

– Advanced age
– Other illnesses that could reduce life expectancy
– Active infections or recent cancer history
– Inability or unwillingness to adhere to necessary lifestyle changes, such as abstaining from alcohol and smoking

Donor Matching

Matching a donor with a recipient requires compatibility in medical and physiological aspects. The process looks at the severity of the patient’s condition, blood type compatibility, size of the donor and recipient, and time spent on the waiting list.

Potential Complications

Heart transplant patients face risks and potential complications, the most significant being rejection of the donor heart. The immune system can perceive the new heart as foreign and attack it. To prevent this, patients are given immunosuppressants to reduce immune activity. These medications also increase the risk of infection, as they weaken the immune system. In the long term, transplant patients may develop different cancers.

Medications

Post-transplant, patients must take various medications to keep the heart healthy and prevent rejection. Despite taking immunosuppressants, around 10% of recipients will experience symptoms of rejection, such as shortness of breath, fever, fatigue, reduced urination, or weight gain, particularly in the first year. Additional medications to prevent bacterial, viral, and fungal infections are also prescribed.

Medical Follow-Up

Regular follow-up visits, including EKGs and heart biopsies to check for rejection, are essential, especially in the first year after the transplant. Over time, the frequency of these visits may decrease, but immunosuppressants are typically required for life, potentially leading to other health issues like kidney damage, increased infection risk, high blood pressure, high cholesterol, diabetes, and osteoporosis.

Cardiac Rehabilitation

Cardiac rehabilitation, which involves exercise and health education, is often recommended to help patients recover and maintain heart health. This individualized program supports patients in leading a heart-healthy lifestyle and improving their overall quality of life. Many transplant recipients who follow their rehabilitation plan can return to work and social activities, enjoying a significantly improved quality of life.