Heart Transplant

Center of Excellence

During heart transplantation a patient's diseased heart is replaced with a healthy donor heart. In the United States, there are between 60,000 and 100,000 people who could benefit from a new heart. But due to an acutely limited supply, only 2,300–2,400 transplants are performed each year. Because of the large discrepancy between demand and supply, heart transplants are reserved for patients with severe end-stage heart disease.

First steps

The procedure for a heart transplant begins with an evaluation by a multi-disciplinary medical team. This team examines four main points:

Is a patient medically fit?
Is the patient sick enough to need a new heart? If so, are there any other medical conditions that would render the patient ineligible for transplant? For example, a patient with kidney failure is not eligible for transplant.

Does the patient have the necessary social support?
Heart transplant is not a procedure patients can go through alone. Patients should have a good social support made up of family or friends who are caring and involved.

Is the patient psychologically fit?
Transplant patients must adhere to strict behavior modifications and regimented rejection medication. Patients should demonstrate a psychological ability to remain compliant long term.

National transplant waiting list

Patients on the transplant list are assigned priorities based on the severity of their conditions. The highest priority is given to patients in rapid decline, generally patients on intravenous medications, balloon pumps, and/or VADs. Lowest priority is assigned to patients with heart failure that has been stabilized. Often these patients are at home.

Once priority is established, other factors affect who gets an available heart, including: 

Geography
Once harvested, a heart must be transplanted preferably within four hours. For example, Montefiore-Einstein patients cannot safely receive hearts from donors in Los Angeles, but they could receive hearts from Boston.

Blood type
Donors and recipients must have compatible blood types.

Body size
Donors and recipients must have compatible body sizes. For example, a heart from a six-foot donor may be too large for a five-foot recipient.

Waiting time
When two recipients are equally compatible matches, the heart goes to the patient who's been waiting longer and is sicker.

Transplant procedure

To make sure that no more than four hours pass between harvesting the heart and transplant, the surgical team who removes the heart from the donor is in constant contact with the recipient team at Montefiore Einstein Health Center.

While waiting for the heart to arrive, the recipient is prepared for surgery as quickly as possible. The patient is placed on a heart-lung machine, and upon arrival of the donor heart, the surgeons remove the recipient's diseased heart, then prepare and implant the new heart.

Following the 90-minute procedure, the patient is removed from the heart-lung machine. Once the heart function is stable, the patient is moved to intensive care unit for further care.

Risk of rejection

Rejection occurs when the patient's immune system recognizes the new heart as foreign and mounts an immune reaction to it. The new heart is biopsied routinely to look for evidence of rejection; if necessary, immunosuppressive medication is adjusted.

At home, patients watch for other signs of rejection, including shortness of breath, flu-like symptoms, and low-grade fever. Although patients must take anti-rejection medication for the rest of their lives, the first year following transplant is the most critical. Fortunately, severe rejection is very rare. Most cases can be handled with by increasing rejection medications.

© 2008 Montefiore Medical Center