Heart Transplant

When medications and surgery fail to manage heart failure symptoms and progression, cardiac transplant is considered as a treatment option. A heart transplant improves length and quality of life for patients with end-stage heart failure.

Screening
Before someone is placed on the heart transplant list, they are placed through a careful screening process. A multidisciplinary team of heart doctors, nurses, social workers, and bioethicists review the medical history, diagnostic test results, social history and psychosocial evaluation results to see if the patient is able to survive the heart transplant procedure and then, comply with the continuous care needed to live a long healthy life.

Waiting
Once the person is approved to be placed on the list, they must wait for a donor to become available. This process can be long and stressful. A supportive network of family and friends is needed to help the patient through this time. The health care team will monitor the patient closely to keep the patient's heart failure in control. Your transplant coordinator will discuss with you how you will be notified if a donor heart is available. The hospital must know where to contact the patient at all times should a heart become available.

The surgery
Once you are in the operating suite, the actual heart transplant procedure can take anywhere from 4 to 12 hours, or longer. Each person's case is different.

The donor heart
A surgeon from the heart transplant center goes to harvest the donor heart. The surgeon will make sure the donor heart is in good condition before beginning your surgery. The donor heart is removed by cutting the aorta and pulmonary artery in the mid-section. The atria are removed from the veins leading into the heart.

The transplant
When the donor heart arrives in the operating room, your surgeon will remove most of your heart and the donor heart will be placed in proper position and attached to your major blood vessels.

Recovery
How quick a patient recovers after heart transplant depends on many factors: age, general health, and response to the transplant. Most patients are up and about within a few days after surgery and home in about 7 to 16 days.

Common questions about heart transplant:

Where does a donor heart come from?

Your new heart must come from someone who has been declared brain dead and whose family consents to donate the organs. It is an anonymous gift. Brain death is a permanent condition usually due to a head injury from a car accident, gun shot wound, or hemorrhage into the brain (like a stroke). It is diagnosed by many tests and confirmed by two physicians who are not involved with the donor's care to determine if it is suitable for a heart transplant.

The donor's heart continues to beat independently and may be supported by dopamine. Respirations are maintained by mechanical ventilation. The donor will undergo blood work similar to your evaluation. The donor will also have an electrocardiogram, echocardiogram, and occasionally a coronary angiogram to make sure the heart is suitable for transplant.

This information is then entered into the UNOS computer and a list of suitable recipients is printed. The list is based on blood type, body size, UNOS status, and length of time on the waiting list. Race and gender of the donor has no bearing on the match.

Because we only have a few hours to perform a heart transplant, we do a crossmatch after your transplant. This involves comparing your blood to the blood of your donor. This test is helpful to us in your post-transplant care. It may help to determine if you will have any rejection.

LifeBanc, is the local organ procurement organization that services Northeast Ohio. LifeBanc is responsible for coordinating all organ and tissue donation in the 20 county area. LifeBanc is also part of a computer network that matches donors and recipients nationwide. For more information, click on the following links (a new browser window will open up):

• UNOS*
• LifeBanc*

Does the heart beat the same once the heart transplant takes place?

The donor heart comes with its own pacemaker and its own coronary artery supply. However, when the heart is removed from the body, the nervous system is disconnected. The heart continues to beat adequately, put without the external nerve supply. This is referred to as a denervated heart. In a small amount of cases, a pacemaker is needed after surgery to help the heart rate.

What is immunosuppression?

Inside your body, you have a system of defense against foreign invaders, called the immune system. Made up of mostly white blood cells, its job is to destroy germs such as bacteria and viruses, and help to fight other diseases. Your white blood cells are made up of different teams of fighter cells, called B and T cells. B cells fight germs by producing antibodies. Antibodies are strong weapons against infections, causing germs to become harmless. T cells kill foreign invaders, such as germs and cancer cells. Each time your body has an immune reaction, it memorizes the foreign body (antigen) and how it was stopped so that it can respond quickly the next time the same antigen is introduced. The immune system is very helpful, but it cannot tell the difference between "bad invaders," and "good invaders," such as a transplanted heart. As a normal response, your body's immune system sees the new heart as a foreign invader and attempts to destroy it. Immunosuppressant mediations are given to stop this process. After a transplant, you need to take measures to prevent infections because you are immunosuppressed.

What is rejection?

If the immune system is able to attack the transplanted heart, it is called rejection. Rejection must be detected and treated quickly to prevent damage to the transplanted heart. After a transplant, you are given the symptoms of rejection to look for and appointments are scheduled regularly with your doctor for checkups and myocardial biopsies to help detect rejection.

Can you get coronary artery disease after a transplant?

Coronary artery disease after a transplant is sometimes called chronic rejection. It can occur anytime after a transplant, but most often several years after transplant. The coronary artery disease is different from the fatty or calcified plaque that occurs in non-transplanted hearts. After a transplant, you must follow a heart-healthy lifestyle to help lessen the risk of future coronary artery disease.

There are many issues facing those who undergo a heart transplant. It is best to understand these considerations prior to undergoing the procedure and then following the recommendations your health care team give you afterward to live a healthier, quality life. The Cleveland Clinic Heart Transplant team works with you each step of the way - from evaluation to recovery. A full patient guide to heart transplant can be found on the transplant website.

The Cleveland Clinic Foundation Heart Transplant program began in 1984, when six transplants were performed. Since then, the program has become one of the largest in the United States. Each year we have expanded our staff of nurses and doctors to care for the growing population of heart transplant recipients.

For more information about Heart Transplant at the Cleveland Clinic, contact the Heart Transplant Center

Learn more about Heart Failure innovative treatments, and the Kaufman Center for Heart Failure, which consists of physicians and surgeons who are dedicated to research and treatment of heart failure.

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