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Heart Transplant
Dilated cardiomyopathy (including ischemic cardiomyopathy) is the most common reason for a heart transplant. Each year, roughly 2,000 heart transplants are performed. The exact number is determined by the supply of donor hearts. There are many more people needing heart transplants than there are donor hearts. More information on becoming an organ donor is available at donatelife.net.
Most people who receive a heart transplant feel better immediately. At hospitals experienced in heart transplants in the United States, nearly 90 percent of heart recipients survive one year or more and about 70 percent survive five years or more. Some recipients have survived 10 years or more if organ rejection is successfully controlled.
Organ rejection is a lifelong risk for heart transplant recipients. Organ rejection occurs when the body's immune system perceives the donor organ as a foreign substance and tries to destroy it, just as the body fights the flu. Even though the donor heart and recipient are matched by blood type and in some cases tissue typing, no two people are exact matches (except identical twins). To minimize the risk of the body's immune system attacking the donor heart, immunosuppressive medication must be taken regularly after a heart transplant. However, suppressing the immune system reduces the body's ability to fight infection, the main side effect of these medications. Other potential side effects of immunosuppressive therapy include high blood pressure, diabetes, kidney function problems, weight gain and certain types of cancers. So it's crucial for heart transplant recipients to prevent infection and closely monitor their overall health.
In general, to be eligible for a heart transplant, patients must be less than 70 years old, with a life expectancy of less than one to three years without the heart transplant. Patients must be motivated for transplantation and able to comply with a lifelong commitment to medical therapy, as well as be free of any medical barriers for transplantation. People with pulmonary hypertension (high pressure in the arteries to the lungs), infection, obesity, unresolved drug (including tobacco) or alcohol abuse, or any noncardiac disease that significantly limits life expectancy or will be worsened by using the immunosuppressive medications required after transplant generally are ineligible for a heart transplant.
Patients must undergo extensive evaluation to determine if they are eligible to receive a transplant and place them on the transplant list maintained by United Network for Organ Sharing (UNOS). Once eligibility has been established, it may take several days to years before a matching donor heart is available. Eligibility status may change over time as your health changes.
Once patients are on the waiting list, some transplant centers require them to relocate within two to three hours' travel of the transplant center. Sometimes patients choose to register for a transplant in multiple areas of the country to increase their chances of getting a heart, if the transplant centers allow it. For more information on the national organ waiting list, you can visit the website of the Organ Procurement and Transplantation Network.
When a donor heart becomes available, UNOS will rank potential recipients according to criteria such as blood type, heart and body size, and urgency of the case as well as how long the patient has already been on the waiting list and distance between donor and recipient. UNOS then contacts transplant centers starting with the highest-ranked patient and work down the list until the heart is accepted for transplant. More information on matching is available from OPTN.
Successful transplantation requires a healthcare team of cardiologists, surgeons, anesthesiologists, infectious diseases doctors, nurses, counselors, physical therapists, and others. Prior to the operation, patients need to have blood tests, urine samples, and a chest X-ray to ensure that their condition is satisfactory. The heart transplantation procedure is a straightforward, open heart procedure usually involving three to four hours of surgery, barring complications. During the procedure, the donor heart is connected to the aorta, pulmonary arteries, and atria or vessels leading to the atria. After the procedure, the patient will spend several days in the intensive-care unit.
Heart transplant recipients are typically discharged from the hospital after about one to three weeks. Ongoing care can be demanding and many transplant hospitals require patients to stay near the hospital for at least three months for follow-up healthcare. The levels of immunosuppressive medications are closely monitored and heart tissue biopsies are collected at regular intervals to check for signs of rejection. Also, because the nerves to the heart are severed during transplantation, heart recipients do not feel chest pain when the oxygen supply to the heart is compromised. Therefore, annual coronary angiograms are necessary to look for atherosclerosis. Heart transplant requires a lifelong commitment to daily medications, regular exercise, abstaining from smoking and alcohol, and regular medical monitoring.
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