Heart Transplantation

Overview

The Transplant Evaluation Process

Before a person can be put on a waiting list for a heart transplant, the determination has to be made that there is no other treatment option available for the person's heart failure. In addition, it must be determined that your body, your emotions, and your family/support system are capable of enduring the transplant process. Once those determinations have been made, there are other steps in the evaluation process. Those steps include, but are not limited to, the following:

• exclusion criteria
  Because of a shortage of donor organs, criteria have been established to ensure that those who will benefit the most from transplant are most likely to receive a donor organ. Your physician will discuss these criteria with you to determine if you are a possible candidate for transplantation. Criteria for automatic exclusion include the following:
  
  
  • patients with active cancer or infection
    
    
  • patients who are overweight
    
    
  • patients who are actively smoking
    
    
  • patients who are actively using drugs and/or alcohol
    
    

  Smokers will be considered for transplant, provided they are otherwise eligible, only if they remain smoke-free for a minimum of three months. Random nicotine screening may be utilized if necessary.

• blood and tissue typing
  Because of the body's immune system, any tissue or organ introduced into a human body that is not a part of that body will cause a natural process to start that will ultimately damage or destroy the foreign tissue or organ. Thus, a potential organ recipient must have blood and tissue-typing tests done so that a donor organ that most closely matches the recipient can be found.
  

  Other evaluation procedures include:

  • blood chemistries
    
    
  • hepatitis and HIV testing
    
    
  • 24 hour urine specimen (to evaluate kidney function)
    
    
  • chest x-ray (to assess for lung infection, other pulmonary diseases, and heart size)
    
    
  • abdominal ultrasound (to assess for gallstones and/or other abdominal conditions or diseases)
    
    
  • EKG (to assess the heart's electrical conduction system)
    
    
  • Holter monitor (to assess the heart's electrical conduction system in further detail than a regular electrocardiogram or EKG)
    
    
  • Panorex or a type of x-ray of the teeth and jaws (to assess teeth for cavities and abscesses that might cause infection after transplant; your dentist will be required to clear you for a transplant)
    
    
  • pulmonary function tests (to evaluate lung function)
    
    
  • right heart catheterization (to assess the pressures inside the heart, which helps your physician to determine your heart's functioning capability)
    
    
• financial evaluation
  Unfortunately, transplantation is a very expensive procedure. In addition, the medications, follow-up visits, and additional post-transplant care are also expensive, and will be necessary for the remainder of the heart recipient's life. Insurance may cover the cost of the transplant procedure itself but may not pay for post-transplant care and medications after a certain period of time. All available assistance will be provided.
  
  
• family situation
  It must be established that any potential heart recipients have an adequate and stable support system.
  
  
• psychological evaluation
  This is done to assist in determining whether a potential heart recipient will be able to comply with the necessary treatment regimen before and after transplant.

What is a Heart Transplant?

Heart transplantation involves removing the diseased heart and replacing it with a healthy heart from an organ donor. In order to remove the donor heart from the donor, the donor must be declared brain-dead.

Once a patient has been approved for transplant, then he/she is placed on a waiting list. This list is a national data base and includes information that will help to identify the most closely-matched organ possible for the recipient. Waiting time may be only a few days or a few weeks, but sometimes it may take months or longer before an acceptable organ is found. While waiting, the patient will be closely followed by his/her physician.

The patient will remain out of the hospital for as long as his/her condition allows. If the condition worsens, the patient may be admitted to the hospital for more intensive therapy. Sometimes, a few days in the hospital is sufficient to improve the patient's condition and the patient may return home. However, it is possible that the heart's condition may worsen to the point that the patient is unable to leave the hospital. At this point, the patient's condition may be changed on the waiting list to indicate a worsening condition, thus giving that patient a higher priority for suitable organs that become available.

Once a suitable heart has been found, a team of physicians will go to the location of the donor and will examine the heart (and other organs) to make sure it is appropriate to use for transplant. If the heart is acceptable, the physicians will remove the heart from the donor, place it in a special solution to help preserve it, place it in a cooler, then return to the hospital to perform the transplant operation.

While the team of physicians is obtaining the donor heart, the recipient is prepared for the heart transplant operation. Once the hospital receives notification that the donor organ is acceptable, the patient is given final preparation for surgery and is taken to the operating room. The diseased heart is removed, and the donor heart is attached. The patient is then taken to the intensive care unit (ICU) to recover from the surgery.

Reasons for the Procedure

Heart transplantation is performed to replace a failing heart that cannot be adequately treated by other means.

Risks of the Procedure

Potential risks associated with heart transplant may include, but are not limited to, the following:

• rejection of the new heart
  
  
• infection (due to immunosuppression necessary to help prevent rejection, persistent infections)
  
  
• bleeding during or after the surgery
  
  
• blood clots that can cause heart attack, stroke, or lung problems
  
  
• breathing problems
  
  
• kidney failure
  
  
• coronary arteriopathy (similar to coronary artery disease)
  
  
• cancer (due to immunosuppressive therapy)

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