Heart Transplant

The pre-transplant evaluation includes a series of tests and exams to make sure you're free of other serious problems that would limit the success of your transplant.

We also consider alternatives to heart transplant, such as:

• Coronary revascularization
• Valve repair and replacement
• Ventricular remodeling

The pre-transplant evaluation includes meetings with a:

• Transplant nurse coordinator
• Cardiologist
• Surgeon
• Social worker
• Psychiatrist, psychologist, and/or psychiatric nurse practitioner
• Pulmonologist
• Infectious disease specialist
• Oral surgeon or dentist
• Dietitian
• Pharmacist
• Chaplain
• Your primary care doctor

Requirements for heart transplant patients:

• Women must have an up-to-date pap smear and mammogram.
• Men must have an up-to-date PSA (prostate screening test) and a prostate exam.

We'll also assess your willingness to take an active role in your health care, vital for your recovery and success after surgery.

Based on your medical history, you may need to see other doctors, including:

• Endocrinologist
• Ophthalmologist
• Nephrologist
• Gastroenterologist
• Neurologist

When is a heart transplant needed?

Heart transplant is considered when the heart no longer can adequately work well and you’re at risk of dying. Reasons for heart transplantation include:

• Inoperable coronary artery disease
• Dilated cardiomyopathy (enlarged heart)
• Congestive heart failure with recurrent hospital admissions
• Unstable angina
• Ventricular arrhythmias that medication or a defibrillator cannot control
• Adult congenital heart disease
• Hypertropic or restrictive cardiomyopathy
• Inoperable valvular heart disease

The heart may be irreversibly damaged by multiple heart attacks or a viral illness that affects the heart muscle. Regardless of the reason, a transplant can dramatically improve a person’s life expectancy and quality of life.

What are immunosuppressive medications?

These medications suppress your immune system to prevent it from rejecting your new heart. You must take these medications exactly as prescribed for the rest of your life. Failure to do so will result in your body rejecting your new heart.

What happens during the operation?

Heart transplants usually take four to six hours. However, you’ll be in the operating room an extra hour or two for preoperative and postoperative care. Your family will be given regular updates regarding your progress.

Prior to the operation, you will be given anesthesia. After you are asleep, the anesthesiologist will place a tube through your mouth into your windpipe to help you breath during the operation and until you are awake afterward. The tube is attached to a ventilator, which will expand your lungs mechanically. A catheter will be placed in your bladder. This tube will drain urine and will remain in place for a few days after the operation. Tubes will be placed into your chest cavity to drain fluids. They will be removed two to three days after surgery.

Small pacing wires will be placed on the outside of your heart and will come out through the skin on your upper abdomen. These will be removed before you leave the hospital.

How are candidates for heart transplant determined?

An evaluation process determines which patients have the best chance at long-term survival. A pre-transplant evaluation is performed by a variety of specialists to determine whether transplantation is the best treatment. The evaluation includes multiple tests and review of your medical, surgical, and psycho-social history. The evaluation is generally done while you are in the hospital. This is a time for you and your family to learn as much as possible about heart transplantation.

At Saint Luke’s, we offer an interdisciplinary team of professionals for your care. This team includes:

• Transplant/heart failure cardiologist
• Cardiac transplant surgeon
• Transplant coordinator
• Social worker
• Psychiatrist/Psychologist
• Pulmonologist
• Infectious disease physician
• Transplant financial specialist
• Dietitian
• Pharmacist
• Chaplain

What tests are part of the heart transplant evaluation?

The transplant team will review all of your previous medical records, as well as cardiac catheterization films and operative reports. They may request such tests as:

• Echocardiogram
• Catheterization of the right heart
• Cardiopulmonary stress test
• Pulmonary function tests
• Blood tests
• Carotid and peripheral vascular testing
• CT scan of chest

How does the waiting list work?

Upon being accepted for transplantation, your name will be placed on the United Network for Organ Sharing (UNOS) national waiting list. For specific criteria, go to https://unos.org/.

Your transplant cardiologist and coordinator will explain your current status and how this may change throughout the waiting period.

When a donor heart becomes available, UNOS identifies the best possible match and notifies the Saint Luke’s transplant team. Donor hearts are matched to transplant candidates based on blood type and body size. Your transplant team will determine whether a particular donor heart is a suitable match for you. The sickest patients with the longest waiting time are offered hearts first. It is impossible to predict how long you will have to wait for a donor heart to become available.

While you’re on the waiting list, it’s important that you stay in close contact with your transplant team and keep them advised of any health issues. You will be seen frequently in the transplant clinic to help you maintain your stability as you wait for the donor heart.

Where do new hearts come from?

Donor hearts come from victims of accidents or head injuries or from someone who has suffered a stroke or brain bleed. The donor is a person who has suffered an irreversible brain injury and has been declared brain dead by medical testing. The identity of a deceased donor and the circumstances surrounding his or her death are kept confidential and not shared with the transplant recipient and family.

All potential donors are evaluated for heart disease, drug or alcohol abuse, cancer, or infection. They also undergo testing for infectious diseases. If this evaluation doesn’t reveal any problems with the heart, donors and recipients are matched according to blood type and body size. Race and gender are not considered in matching.

What happens after a match is found?

When a heart has been identified for you, the transplant coordinator will contact you by phone.

Once you come to the hospital, you will have blood drawn, undergo a chest X-ray, and visit with the surgeon and anesthesiologist. If the heart is compatible, the transplant will proceed. If not, you will be sent home to continue waiting.

What happens after the operation?

Once the surgery is complete, you will recover in the Cardiovascular ICU for two to three days. When you are ready, you will be transferred to another unit called a step-down unit. The usual length of stay is seven to 10 days. If you experience complications, you may be there longer.

Learning how to care for your new heart begins as soon as you have recovered from the anesthesia. You will learn how to take all of the new immunosuppressive medications and how to monitor your blood pressure, pulse, and weight. You will also learn the signs and symptoms of infection and rejection, and when to call your transplant team.

It is important that your family participate with you in learning about your new heart.

What complications could happen after a heart transplant?

The two most common complications are infection and rejection.

Because of the immunosuppressive medications you must take, you’re at increased risk for infection. You’re at the highest risk in the early months after your transplant, but this risk decreases as time passes. However, the risk is never completely gone. Most infections can be successfully treated as they occur.

Your immune system works to destroy foreign substances that invade your body. Unfortunately, it cannot distinguish between your new heart and unwanted bacteria and viruses. Rejection occurs when your immune system attacks your new heart. The immunosuppressive medications you take help keep the immune system in check. As many as 40 percent of heart transplant patients experience rejection at some point after transplant. Most rejections can be successfully treated as they occur.

What happens when I go home?

Heart transplant patients need follow-up medical care for the rest of their lives. Staying in touch with your Saint Luke’s transplant team is critical to your long-term success. Before you leave the hospital, you will be scheduled for an appointment with our Post-Transplant Clinic.

Does Saint Luke’s offer support services?

Saint Luke's provides various support groups throughout the year for our patients waiting for transplant, as well as those already given the gift of life.

Educational opportunities and support gatherings are scheduled periodically throughout the year.

What should I do if my insurance changes?

Anytime there is the possibility of your insurance coverage changing, call us before the changes happen. We can help you make decisions that may affect your coverage. And call us any time you have questions or concerns regarding disability or overall financial coverage.

What do I do if I don’t have medical coverage?

It’s critical that you never lose your medical and prescription coverage. The antirejection medications that you’ll need to take the rest of your life after transplant can cost up to $5,000 a month.

When should I apply for Social Security?

In most cases, you’ll want to apply for Social Security when you become disabled. However, contact your financial specialist before applying. For those receiving Social Security for disability, Medicare will not begin for two years after the qualifying date of coverage.

When is Medicare my primary insurance coverage?

For those patients who are covered for disability, Medicare will remain secondary if you’re enrolled in a large, active group employer plan through yourself, a spouse, or a parent. Medicare will be your primary coverage if you’re covered by an individual, small group, retired, or COBRA plan.

How much does a heart transplant cost?

We’ll help you determine how much is covered by insurance and how much is your responsibility. We’ll work closely with your insurance case manager to coordinate your benefits.