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Heart transplants—frequently asked questions
Where does a donor heart come from?
Donor hearts are always anonymous. Grieving families may donate the organs of a young, healthy individual who has been declared brain dead, usually as a result of a head injury, a car or sports accident, or a gunshot wound, to give someone else a chance at life. Once someone has been declared brain dead and the family decides to donate the still-living organs, the information is entered into the United Network for Organ Sharing computerized list. The UNOS list contains blood type, body size, UNOS status (based on clinical status), and the length of time the person with heart failure has been on the waiting list. Neither the donor's race nor gender has any bearing on the match. A computer network matches donors and recipients nationwide.
How long will I be in the hospital after a heart transplant?
How quickly you recover after a heart transplant depends on your age, overall health, and bodily responses to the transplant. Most patients are up and about within a few days of the surgery and home in a week or two.
After the donor heart is transplanted, will it beat the way it did in its donor?
The donor heart comes with its own natural pacemaker and its own coronary arteries. When the heart is removed, the donor's nervous system is disconnected and there is no way to link the heart to the recipient's nervous system. The transplanted heart usually beats adequately but occasionally needs help from a pacemaker.
What is immunosuppression?
Your body's defense system against foreign invaders such as bacteria and viruses is its immune system, which is composed primarily of white blood cells. Your white blood cells consist of different fighter cells, known as B and T cells. B cells fight germs by producing antibodies, which fight against infections and render germs harmless. T cells kill foreign invaders, such as germs and cancer cells, by engulfing them. Each time your body has an immune reaction, it memorizes the particular "fingerprint" of the invading foreign body—the antigen—so that the immune system can respond quickly when the same antigen invades again. Although your immune system helps protect you against "bad" invaders such as infections, it cannot distinguish between a "bad invader" and a "good invader," such as a transplanted heart. As a result, your body's immune system "thinks" the new heart is a foreign invader and attempts to destroy it. To stop this rejection of your heart transplant, you will need to take immunosuppressant medications for the rest of your life. Since immunosuppression makes you more vulnerable to infections, you will need to prevent exposure as much as you can.
What is rejection?
An attack on your transplanted heart by your immune system is a sign of rejection. To prevent damage to the heart, you and your doctors must be alert to signs of rejection and treat it quickly. After a transplant, your transplant team will teach you how to watch carefully for any symptoms of rejection and where to call if you recognize any such symptoms. Your doctor needs to check you regularly for any symptoms of rejection and perform regular myocardial biopsies that can detect any subclinical rejection before symptoms occur. You will be on special medications—called immunosuppressants—to help prevent rejection for the rest of your life.
Can coronary artery disease return after a transplant?
There are two types of coronary artery disease that can occur post transplant. The first type develops naturally over time (like CAD in patients without heart transplants) or as a result of residual disease from the donor heart that was not detected when it was harvested. The second, more common type is called transplant vasculopathy and can occur at any time after a transplant. Transplant vasculopathy is immune mediated and causes a narrowing of the coronary arteries that cannot be fixed by angioplasty or stenting. Treatment for CAD after a heart transplant is difficult, so prevention is the key: Transplant patients need to follow a heart healthy lifestyle and take medications to reduce their risk of CAD.
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