Heart Transplant Procedure

Overview

A heart transplant is a surgical procedure where a surgeon replaces a damaged or weakened heart with a healthier one from a donor. Doctors consider this option when other treatments have not worked. Key points include:

Reserved for severe heart conditions.
Requires specialized surgery and careful follow-up.
Survival rates are positive with ongoing care.

Term	Description
Heart transplant	Replacing a failing heart with a donor heart
Heart transplantation	Complete process and aftercare

Reasons for Performing a Heart Transplant

Doctors consider a heart transplant when other medical or surgical treatments do not work, and heart failure reaches an advanced stage. The main reason for this surgery is when the heart can no longer pump blood well enough to supply the body’s needs. This often happens because of certain diseases or long-term damage to the heart.

Why Doctors Recommend Heart Transplant Surgery

Common Causes in Adults

Adults may need a heart transplant after:

Damage to the heart muscle, known as cardiomyopathy, which makes the heart weak
Blockages in the heart’s arteries, called coronary artery disease
Heart valve problems that cannot be treated by other methods
Heart rhythm issues (ventricular arrhythmias) that do not respond to other treatments
A heart with problems present since birth (congenital heart defects)
Failure of a previous heart transplant

Common Causes in Children

Most children needing heart transplants have either:

Congenital heart defects, which are heart problems present at birth
Cardiomyopathy, a disease that affects how the heart muscle works

Advanced Heart Failure

Without a transplant, people with end-stage heart failure usually have a poor quality of life and a shorter life expectancy. Doctors use heart transplants for those who are not helped by medication or medical devices and who are likely to survive and recover after surgery.

Other Considerations

Sometimes, a person might need more than just a new heart. Certain medical centers offer procedures that replace both the heart and another organ at the same time:

Multiorgan Transplant Type	Organs Replaced	Common Reasons
Heart-Kidney	Heart and kidney	Both heart and kidney failure
Heart-Liver	Heart and liver	Certain combined heart and liver diseases
Heart-Lung	Heart and both lungs	Severe conditions affecting both the heart and lungs

However, not everyone is eligible for a heart transplant. Some factors, like old age, serious diseases affecting other organs, active infections, or recent cancer, may prevent someone from getting this surgery.

Mechanical Support Devices for the Heart

For patients who cannot have a heart transplant, doctors may use a heart pump called a ventricular assist device (VAD). Surgeons place a VAD inside the chest to help move blood from the heart’s lower chambers to the rest of the body. This supports people while they wait for a transplant. VADs also help people who aren’t eligible for a heart transplant. In these cases, the device becomes a long-term solution to improve blood flow and help the person feel better.

If a VAD alone does not provide enough support, doctors might suggest a total artificial heart. This device completely replaces the lower parts of the person’s heart and serves as a temporary fix until a transplant can take place. These technologies provide important support for patients with severe heart failure or end-stage heart disease when other options are not possible.

Possible Complications

Heart transplant surgery can bring several risks that patients and their doctors need to monitor closely. These risks can appear soon after surgery or develop over time.n Common risks include:

Rejection of the Transplanted Heart: The immune system may see the new heart as something foreign and try to attack it. This can damage the heart and reduce its ability to work. Regular use of medications, called immunosuppressants, lowers this risk, but doctors must monitor patients closely. Rejection may happen with no signs, so frequent check-ups and heart tissue tests are important, especially during the first year.
Primary Graft Failure: Sometimes, the donor heart does not work well after transplant. This is a serious problem and is most likely to occur within the first few months after surgery. The care team must recognize and respond quickly.

Risk	Description
Infection	Higher chance of infection due to immune-suppressing drugs.
Medication side effects	Problems like kidney damage, high blood pressure, or diabetes.
Rejection	Immune system attacks and harms the new heart.
Graft failure	Donor heart struggles to function.
Artery problems	Thickened artery walls may block blood flow.

Infection: Medicines to suppress the immune system help stop rejection but make it easier for infections to spread. Hospital stays may be needed if serious infections occur, especially within the first year.
Medication Side Effects: Immunosuppressants are necessary for transplant patients, but they can also cause problems. Possible issues include kidney damage, diabetes, and high blood pressure (hypertension). Some patients may also be at greater risk for cancer, especially skin cancer and lymphoma.
Blood Vessel and Heart Problems: The arteries in the new heart can get thick and hard. This can block circulation and may cause a heart attack, abnormal heartbeat, or even sudden death.

Transplant patients must take their medications as prescribed and keep up with check-ups to help catch any issues early.

Getting Ready for a Heart Transplant

Starting the Process

Preparing for a heart transplant begins with a referral to a transplant center. Some people are referred by their doctor, while others choose their own center. It is important to check if the transplant center works with your health insurance. When looking at different centers, consider these points:

How many heart transplants the center does each year.
Survival rates for their patients.
Extra support services, like support groups or help with travel and recovery housing.

Information on transplant center performance appears in public databases, such as those from the Scientific Registry of Transplant Recipients. After you select a center, you undergo a full medical evaluation. The evaluation looks at your overall health to see if you are likely to benefit from a transplant. This includes several tests, such as:

Test Name	Purpose
Echocardiogram	Checks how well your heart pumps.
Electrocardiogram (ECG)	Measures electrical signals in your heart.
Blood Tests	Find out blood type and check organ function.
Other Tests	May include chest x-rays and heart catheterization.

Doctors will also talk about your lifestyle, your ability to follow new medical routines, and your emotional strength. To be considered, you may need to quit smoking or using drugs and show you can stick with the transplant team’s instructions. A strong support network of family or friends is important. The process can be stressful, so encouragement and help from loved ones make a difference.

While Waiting for a Donor Heart

When the transplant team finds you are a candidate, your name goes on the waiting list. Getting a donor heart depends on your blood type, size, and how sick you are. Not everyone gets a heart right away; some people wait several months or more.

While on the waiting list, you need regular checkups. The team monitors your heart, kidneys, and liver to watch for changes. Treatments may be updated based on your condition. To improve your chances and health, doctors guide you to:

Eat a balanced diet.
Stay as active as you can.
Take medications as prescribed.

If your heart weakens before a donor is found, doctors may recommend a ventricular assist device (VAD). This machine helps your heart pump blood and keeps you stable while you wait for a healthy donor heart. It is often called a “bridge to transplant.” Your transplant status could change if your health condition gets better or worse. Doctors keep in close contact to adjust your place on the list as needed.

Getting Ready Just Before Surgery

The time between getting the call and starting the surgery can be very short. Donor hearts must be transplanted within a few hours after removal to stay usable. Because of this, transplant centers focus first on patients who are close by, then those farther away.

You may receive a special phone or pager. Keep this device charged and switched on at all times so the team can reach you right away. When a suitable donor heart is available, the team will contact you immediately. Before the call comes, be sure to:

Pack a small suitcase with essentials and a supply of medication (see table below).
Plan your travel to the hospital ahead of time.
Arrange for quick transportation, as some centers can help with this.
Make sure someone can go with you or help you get to the hospital fast.

Items to Pack	Notes
Medications (24-hour supply)	Always have enough for emergency travel
Phone & Charger	Keep your communication device powered
Personal Items	Include toiletries and comfortable clothes
Documents	Bring health insurance and identification

Once you arrive at the hospital, doctors run last-minute tests to match the donor heart to you. This includes confirming your blood type and ensuring the donor heart is in good condition. In some cases, transplant teams may transport donor hearts from other locations and prepare them for surgery.

The transplant only proceeds if both the donor heart and your condition are suitable. Sometimes, the procedure may be canceled at the last moment if circumstances change. Throughout this process, communication and readiness are key. Staying organized and in touch with your transplant team reduces delays and helps the operation proceed as smoothly as possible.

What You Can Expect

What Happens in the Operating Room

Heart transplant surgery is a type of open-heart procedure that often takes several hours to complete. If a person has already had other heart surgeries in the past, this operation usually takes longer. First, doctors give anesthesia so the patient is fully asleep and does not feel pain. Next, the surgical team connects the patient to a heart-lung machine. This machine takes over the job of circulating and oxygenating blood through the body during the procedure.

The surgeon makes a cut in the chest, then carefully opens the rib cage to reach the heart. The unhealthy or damaged heart is removed. The donor heart, which is healthy, is then placed in the chest. The surgeon connects the main blood vessels to the new heart using special stitches. Often, when blood flow resumes, the new heart starts beating on its own. If needed, an electric shock may help the heart start beating.

Once the new heart is working, the surgical team closes the chest. The team may place tubes to drain fluids from around the heart and lungs. Pain medicines help keep the patient comfortable afterward. During this time, a ventilator helps with breathing, and intravenous (IV) lines deliver medications and fluids as needed. The following table gives an overview of the steps involved in the operating room:

Step	What happens
Anesthesia	Patient is put to sleep for the procedure
Heart-lung machine	Blood circulation managed by the machine
Incision and access	Chest opened, ribs separated
Heart removal	Damaged heart is taken out
Implantation	Donor heart is sewn in
Restoration of blood	Blood flow resumes, heart starts beating
Closure and support	Chest closed, tubes and ventilator used

What Recovery Looks Like

Right after transplant surgery, the medical team takes patients to the intensive care unit (ICU) for close monitoring. Most people spend a few days in the ICU before moving to a regular hospital room. The total time in the hospital varies. Many people stay about one to two weeks, but some might stay longer depending on how they recover.

Once home, the care team provides extra monitoring. During the first three months, patients attend frequent follow-up visits. This is the time when the body is most likely to reject the donor heart. The transplant team watches closely for possible problems, such as infection or organ rejection. They also monitor for symptoms like unusual tiredness, not urinating much, fever, trouble breathing, or sudden weight gain. Patients should report these symptoms to the medical team quickly to help treat issues early.

Doctors use a test called a heart biopsy to check for early signs of rejection. In this test, a thin tube goes into a vein in the neck or groin and is guided to the new heart. The doctor removes a small piece of heart tissue and sends it to a lab for testing. Heart biopsies are frequent in the first months after a transplant but tend to become less common over time.

Long-Term Routine After a Heart Transplant

A heart transplant requires lifelong changes. Patients must take anti-rejection medicines (immunosuppressants) every day to keep the immune system from attacking the new heart. Missing doses or stopping these medicines can be dangerous. Because these medicines lower natural defenses, doctors may prescribe other drugs to fight bacteria, viruses, or fungi.

Some anti-rejection medications can increase the risk of other health problems, such as high blood pressure, diabetes, infections, or even certain cancers. Over time, doctors may reduce the dose or number of these drugs if the risk of rejection drops.

To help manage all medications, patients should keep a written or digital list of all current medicines. This can be helpful in emergencies or at medical appointments. Patients should ask the doctor before starting any nonprescription drugs, vitamins, or supplements, since some substances may change how transplant drugs work. The care plan for someone with a new heart covers many parts of life:

Medication Management: Take all medicines exactly as prescribed every day.
Healthy Habits: Follow doctor’s advice on exercise, diet, and sun safety.
Lower Risky Behaviors: Avoid tobacco, limit alcohol, and do not use recreational drugs.
Stay Informed: Regularly go to follow-up visits and report any signs of infection or heart problems right away.
Infection Control: Use good hygiene and avoid crowded or sick environments, especially in the early months when medication lowers immunity.

Cardiac Rehabilitation After Transplant

Most patients join a special recovery program called cardiac rehabilitation. It includes exercise and education to safely build strength, raise energy levels, and improve overall health. In many cases, cardiac rehab starts before a patient leaves the hospital. This program helps with both the physical and emotional parts of recovery from heart transplant surgery.

Outcomes

Sometimes, a new heart does not perform as expected after transplant surgery. This can happen due to several causes, including organ rejection, infection, or problems with blood flow. Doctors often change medications or recommend different treatments to help the heart function better.

In some cases, the new heart might not recover. The medical team may consider a second transplant, depending on the patient’s overall health and risk factors. If there are no further treatment options, patients, families, and the medical team discuss future care wishes.

Possible Next Steps If a Heart Fails

Medication Adjustments: The doctor may change doses or medicines to support heart function.
Additional Procedures: The team may perform a biopsy to check for rejection.
Second Heart Transplant: For certain patients, another operation may be possible.

Emotional and Physical Support

Heart transplant recipients can join cardiac rehabilitation and seek counseling. Family, care teams, and rehabilitation services offer support to help individuals recover and plan their care needs.

Coping and Support

Staying positive and finding ways to cope after a heart transplant supports both mental and physical health. Many people benefit from reaching out to others and making practical changes to support recovery.

Building a strong support network, learning about your condition, and reaching out for help are key ways to handle stress and daily worries. Setting reasonable goals and educating yourself can also reduce anxiety and boost confidence during this new phase.

Healthy Eating and Nutrition

Attention to nutrition helps keep the new heart strong. A balanced diet supports healing, improves energy, and protects against problems like high blood pressure and diabetes. Working with a food specialist, such as a dietitian, can help patients find the best foods for their needs. Some basics for a heart-friendly diet include:

Fill your plate with fruits and vegetables. Aim for a variety of colors and types each day.
Choose lean proteins. Fish and poultry are better options than fatty cuts of meat.
Try plant-based foods. Beans, peas, nuts, and whole grains are good sources.
Keep an eye on sodium and sugar. Select foods labeled low-salt and try to avoid added sugar.
Focus on healthy fats. Choose foods with unsaturated fats, like avocados or salmon, instead of butter or lard.
Add fiber. Fruits, vegetables, and whole grains help digestion and heart health.
Pick low-fat or fat-free dairy. These options support bone strength.
Avoid some fruits. Grapefruit, Seville oranges, and pomegranates can change how certain medicines work—always check with the doctor first.

Table: Foods to Choose and Foods to Limit

Foods to Choose	Foods to Limit
Fresh fruits and vegetables	High-salt snacks and processed foods
Whole grain breads and cereals	Sugary drinks and desserts
Grilled or baked fish/poultry	Fried and fatty meats
Nuts, beans, seeds	Butter, cream, and high-fat dairy
Low-fat or fat-free dairy	Grapefruit, Seville oranges, pomegranates
Avocados, olive oil	Large amounts of alcohol

Staying at a healthy weight, following food safety rules, and drinking enough water each day are also important steps. Too much alcohol should be avoided. Those who need help can ask a dietitian for meal planning tips or simple recipes.

Physical Activity and Movement

Exercise strengthens the heart and supports a healthy mood. Doctors often suggest moving more after a heart transplant, but each person’s activity plan should fit their needs and abilities.

The patient’s healthcare team often helps create exercise programs. Beginning with stretches or slow walks helps the body prepare for more movement. Good choices include:

Walking
Bicycling
Gentle strength exercises
Light aerobic activities

Cardiac rehab programs help people improve stamina and energy by starting slowly, increasing effort gradually, and listening to their bodies. Warming up and cooling down help prevent injury and allow the heart to adjust.

List: Signs to Pause or Stop Exercise

Shortness of breath not going away with rest
Feeling dizzy or faint
Chest pains or irregular heartbeats
Nausea

When these symptoms occur, rest and contact a doctor if they don’t go away. Taking breaks is okay—what matters most is steady progress.