About Heart Transplantation
Heart transplantation is surgery to remove a damaged or diseased heart and replace it with a healthy donor heart.
Why the Procedure Is Performed
A heart transplant may be recommended for:
- Severe angina that can no longer be treated with medications or surgeries to repair the coronary arteries
- Severe heart failure, when medicines, other treatments, and surgery no longer help. Possible causes of severe heart failure are:
- Coronary artery disease
- Cardiomyopathy (disease of the heart muscle)
- Heart valve disease with congestive heart failure
- Severe heart defects that were present at birth and cannot be fixed with surgery
- Life-threatening abnormal heart beats or rhythms that do not respond to other therapy
As a heart failure patient, you will have an extensive pre-transplant assessment to determine the best treatment. If your illness is severe enough, a transplant evaluation will be done. That leads to a review of your case in front of the transplant committee.
After your assessment is completed, a heart failure cardiologist presents the findings to the transplant selection committee. The committee can then decide if you are a transplant candidate.
The transplant committee includes all the people involved in transplantation: cardiac surgeons, the heart failure cardiologist, the transplant cardiologist, social workers, nutritionists, transplant coordinators, nurses, psychologists and any other medical specialty that would be relevant for your care.
Once a patient has been approved as a transplant candidate, the medical staff adds the patient’s information to the United Network for Organ Sharing (UNOS) candidate list.
Patients get matched with donors based on blood group, degree of medical urgency, geographic location and age.
United Network for Organ Sharing (UNOS)
- UNOS is the only source for donor organs. The organ sharing network is divided into OPOs or organ procurement organizations. The OPOs represent a certain geographical region.
- Locally, Scott & White works with the Southwest Transplant Alliance to procure organs for transplant. When unavailable locally, Scott & White can procure organs up to 700 miles away.
- Organs donated in our region can also be shipped to other areas. For example, in 2009 Scott & White shipped 31 hearts to help patients in need. And now, with the creation of our heart transplant center, Scott & White can use donated hearts to help its own patients in Central Texas.
Life on the Donor List
After a patient qualifies for the UNOS candidate list, it can be a long process before they receive a donor heart. The selection process is based on medical urgency, the patient’s size and blood group. The mean national average to receive a donor heart is 4.6 months; in Texas, the average is 4.9 months.
Medical urgency is based on the patient’s status:
- Status 1A – the patient is the sickest. Some of them have to have some kind of medical support or be hospitalized in the ICU on medications to keep their hearts working.
- Status 1B – patients who are out of the hospital on IV medications, which are called allotropes. These help the heart to continue contracting.
- Status 2 – heart failure patients who are doing OK. They do not require IV medications to keep them going.
In Texas, 100% of patients who receive heart transplants are either Status 1A or 1B. Over the past two years, there have been no transplants on Status 2.
Preparing Mentally and Physically for Your Heart Transplant Surgery
If you are a candidate for a heart transplant, the heart failure cardiologist will make sure that you are taking your medications and staying as healthy as possible while waiting for a suitable donor heart.
The medical staff will also work with you to optimize your nutrition. You will meet with a heart transplant nutritionist to make sure you understand your dietary restrictions and the things you need to do to improve your nutrition while waiting for a heart transplant.
You will also meet with a social worker who will help you with any social issues you may be having, plus a financial counselor to help you deal with insurance issues related to transplantation, and a psychologist.
What to Expect the Day of Your Transplant Surgery
The process starts with a phone call alerting the heart transplant team of an available donor heart from UNOS. If the transplant team is interested in the heart, then they will examine its characteristics.
- What is the quality of the heart?
- What caused the donor's death?
- What were the physical characteristics of the donor?
- What was the donor’s blood group?
- What was the donor’s medical history?
Donated hearts aren’t perfect. They all have some degree of dysfunction secondary to the dying process. The medical staff must assess and decide if it’s a suitable heart for transplantation.
As the recipient, you will be given a pager that will alert you if an organ fitting your characteristics is available for transplantation. You will then contact the hospital to find out if the medical team is going to accept the donor heart. If so, you will be instructed when to arrive at the hospital for surgery.
Recent events such as a prolonged sickness, lung infection or pneumonia may disqualify a patient from receiving a donor heart.
Two teams are assembled for transplantation — the team acquiring the organ (Team A) and the team performing the transplant (Team B) — and the transplant process begins.
Step 1: Team A approves the donated organ for transplantation and Team B prepares the heart transplant recipient for surgery.
Step 2: Team A travels to the hospital where the donor heart is being extracted from the deceased donor.
Step 3: As Team A arrives back at Scott & White with the donated heart, the recipient’s non-functioning heart is removed.
Step 4: The donated heart is transplanted into the recipient.
No time is wasted. It’s best if the transplant process takes less than four hours. The less Cold Ischemic Time (CIT), the better the heart functions after surgery. Everything is timed and all details are worked out so no time is wasted.
The surgeons and transplant teams involved in the heart transplant process are in constant communication from organ acquisition to transplantation.
After the surgery, you will be taken to the Intensive Care Unit (ICU). You will then be given immunosuppressive medications, sensitive to your medical profile, and monitored closely to make sure your body is not rejecting the new organ.
What to Expect After Your Heart Transplant Surgery
Hospitalization and Recovery Time
As a transplant patient, you can expect to be hospitalized for two to four weeks. Recovery can take up to eight weeks if there are no other medical complications like infection or organ rejection.
Your Responsibility After Heart Transplant Surgery
You must follow your physician's instructions and take immunosuppressive medications for the rest of your life. You must follow a strict protocol of cardiac biopsies to make sure rejection has not occurred.