Heart Transplant

A heart transplant is a surgery that replaces your heart with a donated heart from another person. It’s a last-resort treatment for end-stage heart failure. This means your heart has permanent damage or weakness that keeps it from pumping enough blood to your body.

Most people who receive a transplant have heart failure from one of the following:

• Cardiomyopathy
• Congenital heart disease
• Heart valve disease

Heart transplants are possible for children and adults up to age 70 (and in some cases up to age 75).

Although rare, heart transplants are more common now than they used to be. In 2025, surgeons in the U.S. performed 4,587 heart transplants. In 2015, that number was 2,804.

How should I prepare for heart transplant surgery?

After your cardiologist refers you to a transplant program, you’ll start working with the team there to prepare for surgery. The first step, though, is making sure that you meet the criteria for a heart transplant. If you do, you’ll join the waiting list. While you’re on the waiting list, you’ll receive treatments, like medications or devices, to “bridge” you until transplantation.

Here are the basic steps:

1. Transplant evaluation: This involves many tests (blood, urine, imaging and more) that make sure you’re a heart transplant candidate. You can only receive a donor heart if there’s a good chance of survival and improved quality of life. Also, as you’ll be immunosuppressed after the transplant and at higher risk of infection, you’ll need to be up to date on all of your vaccinations.
2. Waiting list: This is a pool of possible recipients. Where you are on the list depends on your status from one to six (one being the sickest, and six being the most stable), your blood type and the number of days at that status.
3. Bridge treatments: These help you survive, ensure your other organs don’t become damaged and manage symptoms. Your care team may recommend one or more treatments, like medications or mechanical support (ECMO, a total artificial heart or a ventricular assist device).

How long do I have to wait for a heart transplant?

Some people receive a new heart the day they’re added to the list. Others wait months or years. In general, the more urgently you need a heart, the more likely you are to have a shorter wait. But there’s no guarantee.

There are far more people who need a transplant than available hearts. Plus, the donor heart must match your blood type, immune cells and body size.

In the U.S., the United Network for Organ Sharing manages the waiting list and can help you learn more about the process.

What happens during heart transplant surgery?

During heart transplant surgery, a surgeon detaches your heart from its major blood vessels and then replaces it with a donor heart. It’s a complicated surgery that takes about four to 10 hours. Your care team will perform the following steps:

1. Give you general anesthesia: A heart transplant always involves general anesthesia, which puts you into a deep sleep.
2. Connect you to a ventilator: While you’re asleep, providers connect you to a machine called a ventilator that breathes for you during surgery.
3. Make an incision: This procedure is called a sternotomy. Your surgeon makes a long cut down the middle of your chest to access your heart.
4. Connect you to a heart-lung bypass machine: This device acts as your heart and lungs during surgery. It circulates blood to all of your other organs and tissues to keep you alive when your heart is removed and replaced with the donor heart.
5. Remove your heart: Your surgeon clamps off the blood vessels that connect to your heart. Then, they disconnect your heart.
6. Implant the donor heart. Your surgeon attaches the donor heart to your blood vessels.

Your new heart may need help to start beating. If so, your care team may need to use an electrical pacing device. This device works like a pacemaker but doesn’t stay in your body as a permanent pacemaker would.

What are possible risks and complications?

Possible risks and complications of heart transplant surgery include:

• Organ rejection, which means your body’s immunity fights the new heart
• Infections due to immune system suppression
• Graft failure, which means part of the connection between your body and the donor heart fails
• Cardiac allograft vasculopathy, which means your immune response leads to narrowing of your coronary arteries
• Kidney disease and kidney failure
• Osteoporosis
• High blood pressure
• Nerve damage
• Diabetes from the steroids you take to suppress your immune system
• Irregular heart rhythms (arrhythmias)
• Stroke
• Delirium
• Depression
• Higher risk of cancer due to the immunosuppression

Your care team will closely monitor you for any signs of complications in the days and weeks following your heart transplant. Most deaths due to graft failure occur within 30 days after surgery. Most deaths due to infections occur within the first year.

What are the advantages of heart transplantation?

The biggest advantage of heart transplantation is that it can save your life when you have no other options available. Heart transplantation may be the only option if other treatments:

• Haven’t helped you
• Have a low chance of helping you
• Are too risky for you

What are the disadvantages of heart transplantation?

The biggest disadvantages of heart transplantation are:

• Donor hearts are scarce. There aren’t enough donor hearts available to help all the people who need a heart transplant.
• It’s an extremely complicated surgery. So, it can only be done at the most well-equipped hospitals.
• Some people may be too ill to survive the procedure.
• The procedure has several potential risks and complications (see below).

What are the risks of heart transplantation?

The most common risks and complications of heart transplant surgery include:

• Organ rejection.
• Infections (because of immune system suppression).
• Graft failure (where part of the connection between your body and the donor heart fails for any reason).
• Cardiac allograft vasculopathy (CAV).
• Kidney disease and kidney failure.
• Osteoporosis.
• High blood pressure (hypertension).
• Nerve damage.
• Irregular heart rhythms (arrhythmias).

Other possible complications include:

• Stroke.
• Delirium.
• Pain.
• Depression.

What happens after cardiac transplantation?

After surgery, you’ll:

• Recover in the hospital: You’ll stay in the hospital for about three weeks. For the first few days, you’ll be in the intensive care unit (ICU), where providers monitor you around the clock. They’ll check your vital signs and watch for any signs of complications.
• Receive a care plan: Before you leave the hospital, your provider will give you a care plan that you should follow while recovering at home. They’ll also tell you when and how to join a cardiac rehab program. This is a monitored program that strengthens your heart.
• Start taking immunosuppressant medications: These prevent your immune system from attacking your new heart. You need these medicines for the rest of your life.

How long does it take to recover?

Your incisions should heal in about six to eight weeks. You’ll need several months to fully recover. Heart transplant surgery is complicated and extensive, and those who need a heart are often very sick leading up to the surgery. Recovery times are typically longer than for most heart surgeries.

Heart transplant survival rate

Survival and life expectancy after a heart transplant depend on many factors, including your age and overall health at the time of the transplantation and any complications that may arise afterward.

Your transplant team can give you the most accurate information based on your situation and your hospital’s outcomes. In general, survival and life expectancy are improving as time goes on. Research shows:

• About 91% of people who have heart transplants in North America are still alive one year after their surgery.
• The median survival is around 14 years (by 14 years, 50% of transplant recipients will still be alive). Some people can survive over 20 years.

Although a second heart transplant can sometimes be done, surgery and preparation will be more complex than for the first transplant. Some people have received two or three transplants in their lifetime.

When should I call my healthcare provider?

Your transplant team will set up a schedule of follow-up visits. These visits are essential for a successful recovery. Your team will talk with you about medications you need to take, as well as when to get preventive dental care, vaccines and routine health screenings.

Call 911 or your local emergency number if you have any of the following symptoms as you recover at home:

• Fever
• Drainage or oozing from the wound
• Redness/discoloration or a feeling of warmth around the wound
• The feeling that your chest bone is moving or making a cracking/popping sound
• Fast heart rate
• Dizziness
• Shortness of breath
• Any general feeling of illness that’s new

Can a male have a female heart transplant?

Yes. This is called sex-mismatch. In general, females have slightly smaller hearts than males. But your donor heart will be well-matched to you for your size.

Are there any emotional or behavioral changes that result from a donor heart?

No. Research hasn’t shown any changes in psychosocial behavior after a heart transplant.