A heart transplant is only done when it is absolutely necessary and likely to have long-term success. The process of getting accepted into Cleveland Clinic’s heart transplant program involves several steps to ensure the best possible outcomes for every patient.

Step 1: Referral to the program

There are two ways to be referred to Cleveland Clinic’s heart transplant program – by your doctor or you can refer yourself.

Specifically for outpatient transplant or VAD evaluations, please call 216.445.1844.

Transplant referrals can be submitted online through our referral portal.

Consideration of an outpatient transplant or VAD evaluation is recommended when a patient meets any of the C-I-NEEDHELP criteria, which are: Cachexia, Inotropes, NYHA class IV or high Natriuretic peptides, End-organ dysfunction, Ejection fraction <20%, Defibrillator shocks, >1 HF Hospitalization in past year, Edema or Escalating diuretics, Low blood pressure, Prognostic medications de-escalated.

Step 2: Transplant Evaluation

Every patient interested in a heart transplant must have a comprehensive evaluation. The evaluation is done to find out exactly how advanced your heart disease is and to create the best plan of care for you. The evaluation takes 3 to 4 days and includes tests and procedures, meeting the members of the transplant team and getting information about all possible medical and surgical treatment options, including heart transplant.

The team members will talk to you about many aspects of heart transplantation, including:

  • How patients are selected for the heart transplant program
  • Your support system and any issues that may affect your ability to be selected for a transplant
  • Financial responsibilities associated with a transplant
  • The importance of following your plan of care before and after your transplant

Tests that you may have during your evaluation include:

  • Blood tests
  • Chest X-ray
  • Urine test
  • EKG
  • Echocardiogram (echo)
  • Cardiac stress test
  • CT scan
  • MRI
  • Right heart catheterization
  • Biopsy
  • Ultrasound
  • Pulmonary function test
  • Endoscopy
  • General health screening
  • Psychosocial evaluation

You will get detailed information about your evaluation and the testing after they are scheduled. After you complete your evaluation, your test results and other information will be reviewed by a committee to determine if you need a transplant at this time and anticipated to benefit from a transplant. Your insurance company must also approve the transplant. After you are fully approved for a transplant, you will be placed on the United Network for Organ Sharing (UNOS) national waiting list.

Step 3: Waiting for transplant

Being placed on the UNOS waiting list does not guarantee you will get a heart transplant. It is critical that you follow your plan of care and do not miss any follow-up appointments.

The organs used for transplant are based on criteria from UNOS and include:

  • How sick you are
  • How long you have been waiting for a transplant
  • Your height and weight
  • Your blood type

Step 4: Getting a transplant

The heart transplant national allocation system is based on medical urgency. The most urgent patients usually require hospitalization and life support while other patients are more stable.

Step 5: After your transplant

Your recovery in the hospital

You will stay in the hospital about 10-20 days after your heart transplant. Your stay may be shorter or longer, depending on how quickly you recover. Your recovery starts in a cardiovascular intensive care unit (CVICU), where you will be closely monitored around the clock. You will complete your recovery on a special heart transplant patient recovery floor.

Your recovery after you leave the hospital

The goal of your recovery is to have an active life; however you will need to limit some activities as you continue your recovery at home. Your doctor will talk to you about these restrictions and when you will be able to get back to a normal routine.
You will have regular follow-up appointments, testing and biopsies to check for any signs of organ rejection, infection or other problems. If you do have a problem, you may need to have more frequent visits or be admitted to the hospital for treatment or surgery.

Following your plan of care

The success of your transplant depends very heavily on how well you follow your plan of care. This includes:

  • Taking all medications exactly as prescribed
  • Keeping all follow-up appointments
  • Having blood tests or other tests on time
  • Following your recommended diet and fluid guidelines
  • Following your activity guidelines
  • Following all other medical advice and instructions from your transplant team
  • Contacting your post-transplant coordinator right away is you have any issues or concerns

Preventing infection

Your risk of infection and cancer are higher after a heart transplant because one of the medications you need to take weakens your immune system. It is important to avoid being around people who have an infection and to call your doctor right away if you have any signs of infection. Your doctor will talk to you about what these signs and symptoms are.

Heart Transplant Rejection

Organ rejection is one of the risks of a heart transplant procedure. It is possible that your body will reject your new heart right away or over time. Regular biopsies and follow-up visits help your transplant team know if there are any signs of organ rejection. Your doctor will talk to you about the different types of rejection and the appropriate treatments for each.