A heart transplant is a surgery that replaces your heart with one from an organ donor. This is only used when you are too sick to survive without a transplant and only if you meet strict criteria. Thanks to advances in medicine, heart transplantations have a high success rate. People live for years or even decades after receiving their new heart.
A heart transplant is a surgery that replaces your heart with a donated heart from another person. To receive a heart transplant, you must be very ill despite medical therapy and need a new heart to survive. Because there’s a limited availability of donor hearts, you also must meet very strict requirements to qualify for this kind of transplant.
Like other organ transplant surgeries, heart transplants are difficult operations that have risks. After receiving a transplant, you’ll need medical care for the rest of your life to prevent rejection and complications.
A heart transplant is a last-resort treatment for people who have end-stage heart failure. That means your heart has permanent damage or weakness that keeps it from pumping enough blood to your body.
This kind of heart failure can happen for a wide variety of reasons. Most people who need a heart transplant have one of the following conditions:
Heart transplants are possible for children and adults up to age 70 and in some circumstances up to age 75.
How common are heart transplants?
Heart transplants are rare. In 2020, just under 8,200 transplants were performed worldwide. The country with the highest number (3,658) was the United States. The countries with the next highest totals were Germany, France and Spain.
Heart transplants are uncommon for two reasons:
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The following steps happen before your heart transplant surgery:
These steps are described in greater detail below.
To begin the process, your healthcare provider must refer you to a heart transplant program. Then you can schedule your evaluation.
There aren’t enough available heart donors to provide a heart to everyone who needs one. So, the evaluation ensures that you have the best chance to benefit from one long-term.
Your transplant evaluation includes several parts.
Your healthcare provider checks your overall health by running several different tests. Some, but not all, of the possible tests are listed below.
Lab testing includes blood and urine tests that examine your:
Imaging tests you may need include:
Diagnostic tests check the function of your heart, respiratory and circulatory systems. These may include:
Testing for specific diseases is also possible, especially the following:
Psychological and neurological evaluation
Part of the selection process includes psychological and neurological testing and evaluation. That’s because maintaining a healthy heart transplant is stressful and at times challenging. People who receive a transplant also face an increased risk of depression. Neurological tests check for issues that might cause you additional problems.
Your oral health, especially the condition of your teeth, can play a big role in your heart health. It’s common for oral infections from cavities to spread to your heart and cause damage there.
Social and financial evaluation
Heart transplant is a difficult, intensive process. People with the best chance of success also have a good support system around them, including family and friends. The transplant team will talk with you about your situation and learn what resources you might need to get through the process.
If the screenings and evaluations find that you’re a good candidate, the next step is for transplant list coordinators to add you to the waiting list. The list prioritizes people based on their current health condition and how long they’ve been waiting. The more urgently you need a heart, the higher on the list you tend to be.
Bridge treatments are therapies, medications or other types of care that help you while you wait for a transplant. These therapies help you have fewer and milder symptoms.
Potential bridge treatments include:
A heart transplant is a complicated surgery. Your care team will perform the following steps.
After your heart transplant, you can expect the following:
When you’re back home, it’s important to closely follow your plan of care. Your plan will include instructions for:
It’s also essential to learn what’s normal during recovery, and what signals a problem. One example is knowing what your resting heart rate should be.
After your heart transplant, your resting heart rate usually stays at the high end of normal or slightly higher (90 to 110 beats per minute). This is because the donor heart doesn’t automatically connect with your body’s nervous system, which controls your heart rate. Talk with your provider about the resting heart rate you can expect and how it might change in the future.
After your surgery, your provider will start you on medications that suppress your immune system. These immunosuppressants are essential medications for transplant recipients.
That’s because your immune system’s normal reaction to a foreign object (like a donor heart) is to treat it like an infection or other harmful invader and attack it. The immunosuppressant medications protect your new heart from attack by your own immune system. You’ll need to take these medications for the rest of your life.
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:
The biggest disadvantages of heart transplantation are:
The most common risks and complications of heart transplant surgery include:
Other possible complications include:
Heart transplant surgery is a complicated, extensive surgery. Recovery times are typically longer than most heart surgeries. You’ll need to stay in the hospital for at least 10 days, and possibly up to three weeks. How long you spend in the hospital depends on your specific situation and how the surgery went. Overall, you’ll need several months to fully recover.
In the U.S., about 91% of adult heart transplant recipients live at least one year after the surgery. The risk of death is highest in the first year. The most common causes of death within the first year are:
After the first year, graft failure remains one of the most common causes of death.
After five years, cancer becomes a common cause of death. A major reason is the immunosuppressant drugs you take to avoid organ rejection. These drugs reduce your body’s ability to stop malfunctioning cells, making you more vulnerable to cancer.
About half of all people who receive a heart transplant live more than 10 years after the procedure. Advances in medicine and transplant care mean more and more people live 20 to 30 years or more after their transplant.
Pediatric heart transplant recipients (children ages 17 and under) also tend to have good outcomes. About 92% live at least one year after their transplant, and slightly more than 70% live at least 10 years.
Some adults and children need a second transplant to replace the first. This is called a retransplantation. It may be necessary if your body rejects the first transplanted heart, or for other reasons.
Retransplantations account for 2% to 4% of heart transplant surgeries in adults, and about 5% of those in children.
Your healthcare provider is the best person to tell you when you can return to your usual activities. It depends on how your recovery is going and your overall health.
You likely won’t be able to drive for at least six to eight weeks after your surgery. You also shouldn’t lift anything heavier than 10 pounds for at least six weeks. Your provider will give you specific instructions that you should closely follow.
You should limit or eliminate alcohol consumption after your heart transplant. Alcohol contains many calories but no nutritional value. Alcohol causes your triglyceride level to go up, which isn’t good for your blood vessels and heart. A heart transplant gives you the chance to be healthier and stronger than before. So, it’s important to do whatever you can to support your new heart and keep it working at its best.
If you do choose to drink alcohol, limit your consumption to one drink per day. This means no more than:
If you find it hard to drink less or quit, talk with your healthcare provider. Your provider will share resources to help you.
You can safely receive some vaccines if you’ve had a heart transplant. For example, the flu shot is safe and helps you stay healthy after your transplant. There’s no risk of catching the flu from the flu shot because the virus is dead. But there’s an exception: You shouldn’t have the nasal spray flu vaccine because it contains a live form of the virus.
Any vaccine that’s considered “live” can be dangerous for transplant recipients. These vaccines contain a weakened form of a virus that’s harmless for most people. But your immunosuppressant drugs make you more vulnerable to sickness. So, live vaccines may make you sick. It’s also risky for you to be in close contact with someone who recently received a live vaccine. If someone in your household needs a live vaccine, talk with your healthcare provider about any precautions you should take.
In general, talk with your healthcare provider before receiving any vaccine to make sure it’s safe for you.
Your healthcare provider will set up a schedule of visits after your procedure, especially within the first three months. These visits are essential for a successful recovery.
As part of your follow-up appointments, your provider will order tests to check for signs of organ rejection. Your provider will also explain what symptoms to look out for and tell you when you should call your care team.
Your healthcare provider will also talk with you about the importance of:
Call 911 or your local emergency number if you have any of the following symptoms of complications as you recover at home:
A note from Cleveland Clinic
A heart transplant can be a life-saving medical procedure. But there’s a limited supply of donor hearts. Healthcare providers can help determine if you’re a good candidate for a transplant, and if so, help you prepare for the next steps. Thanks to advances in medicine, most people enjoy a better quality of life after their transplant. In the long-term, it’s possible to live years or even decades after your heart transplant, giving you a chance to make new memories with your loved ones.
Last reviewed by a Cleveland Clinic medical professional on 10/03/2022.
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