Heart Transplant

You may be a candidate for a heart transplant if you’ve developed severe heart failure from conditions like:

• Cardiomyopathy.
• Coronary artery disease (CAD).
• Congenital heart disease (CHD).
• Valve-related heart disease.

It’s important to understand transplantation is a complex process — with many medical, ethical and psychological considerations. And we only do it if we feel it’s the last treatment left to try — and if we expect it to be successful long-term. There are many reasons for this.

First, there aren’t enough available heart donors to meet transplant needs. And you could wait a long time for the best match. So, we want to be sure you’re mentally, physically and emotionally prepared for waiting.

We also want to be sure that, medically, you’re a good fit so we can reduce the chance of transplant failure as much as possible. And it’s important to know if you’re committed to following a lifelong care plan after your transplant.

Our team of experienced heart transplant providers spends time getting to know you and doing tests to make sure you get the best treatment for your needs. We might learn that you may respond to other medications and treatments better than a heart transplant. That’s why we have a detailed process — from deciding if surgery is right for you to a personalized recovery plan.

What to expect during your consultation

If you’re referred to us for a potential heart transplant, you’ll have three to four days of appointments and testing. We’ll go over how we decide if we’ll select you for a heart transplant. We’ll also talk about the importance of keeping up with care before, during and after the transplant.

Your story is important to us. So, we’ll first ask you why you were referred to us. We’ll want to know:

• If you’ve had any prior testing.
• What kind of symptoms you’ve had.
• How long you’ve had symptoms.
• How the symptoms are affecting your life.
• What medical conditions you’ve had.
• What surgeries, if any, you’ve had.

And we’ll do a physical exam to check out your overall health and order tests, like:

• Cardiac blood tests.
• Complete blood count (CBC).
• Comprehensive metabolic panel (CMP).
• Urinalysis.
• Prothrombin time (PT) test.
• Electrocardiogram (EKG).
• Exercise stress test.
• Heart (cardiac) catheterization.
• Holter monitor.
• Lung (pulmonary) function tests.
• Echocardiogram (Echo).
• Chest X-ray.
• CT scan (computed tomography scan).
• MRI (magnetic resonance imaging).
• Ultrasound.

You’ll also have blood tests for specific conditions, like tuberculosis (TB), HIV and hepatitis B and C, and others. And we’ll do drug, alcohol and tobacco testing. It’s important to avoid using those things for quite some time before your transplant. You’ll also need to be up to date with all your vaccines.

As part of your transplant consultation, you’ll also meet with a social worker. They’ll go over your strengths and how well you can handle medical treatments and stress. We call this a psychosocial exam.

And you’ll talk about other things that can make you a good transplant candidate. This may include the kind of support network you have and what your home life is like. Having a strong team of friends and family on your side is important for transplant success.

Meet Our Heart Transplant Team

Many different providers work together to help you have a successful heart transplant. Besides your cardiologist and social worker, your care team may also include:

• Cardiothoracic surgeons.
• Anesthesiologists.
• Transplant coordinators.
• Nurse practitioners.
• Physician assistants.
• Cardiac rehab.
• Psychologists.
• Pharmacists.

If you’re accepted as a heart transplant candidate at Cleveland Clinic, it means our team believes:

• Your heart condition will improve from the complicated and aggressive treatment.
• A transplant will improve your health, keep you out of the hospital and extend your life.
• You have no conditions that would prevent successful surgery and recovery.

Preparing for surgery

If it looks like you could be a good candidate, we may recommend important lifestyle changes before surgery, like:

• Working with a dietitian.
• Quitting smoking.
• Doing cardiac rehab to get stronger.
• Meeting with a psychologist.

We want to make sure you’re mentally, physically and emotionally prepared for your transplant so you can have the best surgery and recovery outcome.

Joining the waiting list

Once accepted, your name will go into the nationwide United Network of Organ Sharing (UNOS) computer list to wait for a match. It’s important to understand that getting on the waiting list doesn’t guarantee a transplant. Your match is based on many things, including your blood type, body size, health status and the condition of your heart.

Sometimes, you can get matched to a donor heart quickly. Other times, you may need to wait a month or two, or even a year. While you wait, we’ll continue to check in on you and do testing every three months to see if your condition’s changed. That can affect your position on the list.

Understanding bridge treatment

You may need to continue heart failure treatment while waiting for a donor match. We call this bridge treatment. It helps keep your heart working as best it can.

You may take different medications to help your heart pump blood, control your blood pressure and maintain a steady heart rate. Your providers may also recommend mechanical circulation devices (MCDs), like:

• Intra-aortic balloon pump (IABP): A mechanical device that makes it easier for your heart to pump blood.
• Ventricular assist devices (VADs): Different types of implanted devices that help your heart circulate blood through its lower chambers (ventricles).
• Total artificial heart: A pump that replaces damaged ventricles to keep you healthy enough until the transplant.
• EMCO (extracorporeal membrane oxygenation): A life support system that helps blood flow through your body, while giving your heart and lungs a chance to rest.

What to expect during a heart transplant

The moment news comes of a donor match, things will happen pretty quickly. When it’s finally time, we’ll give you anesthesia to put you to sleep. Once you’re asleep, we connect you to a ventilator that’ll help you breathe during surgery and to a heart-lung-bypass (cardiopulmonary bypass) machine. This keeps your blood circulating throughout your body. During surgery, we clamp the blood vessels connected to your heart and disconnect your heart from them. We then attach the donor heart to these vessels. And after that, we warm and restart your new heart.

Traveling for heart care at Cleveland Clinic

We know that traveling for any kind of healthcare can be stressful and intimidating. If you’re coming to us from another city, state or even another country, we’re here to help make things as easy and convenient as possible. From knowing where to stay and eat to knowing how to get to and from the airport, shop or just find your way around any of our hospitals, we’re here for you.

If you’re an international patient, our experienced and compassionate Global Patient Services team will help you navigate Cleveland Clinic. They’ll connect you with the healthcare providers you need, help you make appointments, provide language translation services and coordinate follow-up care when you return home.

Life After a Heart Transplant

After surgery, you’ll stay in the hospital for up to three weeks. Usually, it’s about 12 days. You’ll start your recovery in the intensive care unit (ICU) so we can keep an eye on your vital signs and make sure your body isn’t rejecting your new heart. Eventually, we’ll move you to a regular room on our heart transplant recovery floor.

Our goal for a successful heart transplant? To help you lead as active a life as possible. But when you first leave the hospital, you’ll need to ease back into things as you recover at home. Your providers will create a personalized care plan that’ll include information about getting back to your routine and what life will be like going forward after a transplant. You’ll have a post-transplant coordinator who’ll check in with you — and who can answer any questions or handle any concerns you have.

Your care team will give you clear and easy-to-follow instructions and advice. It’ll take about six to eight weeks for your incisions (cuts) to heal. And you’ll need to wait this long to drive again. You should also avoid lifting heavy things.

It’s also important that you go to your regular follow-up and testing appointments. And be sure to take all your medications exactly as prescribed. These steps can help you avoid heart transplant rejection.

Taking the Next Step

Receiving a new heart is a lifesaving, medical miracle. It’s not yet one that’s an everyday occurrence, but it’s one that we’ve helped happen more than 2,000 times at Cleveland Clinic. Our experienced team can be there for you every step of the way to find out if you’re a candidate for a heart transplant, or determine which of the latest advanced heart failure treatment options is right for you.