Heart Transplant

What Is It?

A heart transplant is surgery in which a patient with a life-threatening heart problem receives a new, healthy heart from a person who has died. In a heart transplant, the patient who receives the new heart (the recipient) is someone who has a 30 percent to 70 percent risk of dying within one year without a new heart. The person who provides the healthy heart (the donor) is usually someone who has been declared "brain dead" and is still on life-support machinery. Heart donors are usually younger than 50, have no history of heart problems and do not have any infectious diseases.

The recipient and donor must be a good match in terms of specific chemical characteristics (called antigens) found on their cells. A good match will reduce the risk that the recipient's immune system will see the donor heart as a foreign object and attack it — a process called organ rejection.

Currently, surgeons perform 2,300 to 2,500 heart transplants each year in the United States. More than 4,000 people remain on the national waiting list for a donor heart. At these rates, up to 30 percent of patients on the waiting list will die before a suitable heart is found. Potential donor hearts are located through an organization called the United Network for Organ Sharing (UNOS).

What It's Used For

A heart transplant treats irreversible heart failure when other treatment options fail. In the United States, heart transplants are performed for several types of cardiac illness, including:

• Severe coronary artery disease (about 45 percent of cases)
• Cardiomyopathy, an illness that damages the heart muscle (42 percent)
• Congenital heart disease (7 percent to 8 percent)
• Irreparably damaged heart valves (2 percent)
• A second transplant after a first heart transplant fails (about 3 percent)

Preparation

To get into a heart transplantation program, you must meet certain requirements. Although these vary slightly from program to program, the typical heart transplant candidate usually fits the following profile:

• Is younger than 60, but likely to die within one year without a heart transplant
• Has no other potentially life-threatening medical problems except for heart disease. Problems that can disqualify a candidate include significant kidney disease, HIV, pneumonia or another active infection, cancer, a history of stroke or significant circulatory problems affecting the brain, and severe type 1 (insulin-dependent) diabetes.
• Is emotionally stable
• Is willing to follow the rigorous program of lifestyle changes and medication that is necessary after a heart transplant