A heart transplant is an open chest surgery that replaces a diseased heart with a healthy heart from a donor.
Who Might Need a Heart Transplant?
Patients may be a candidate for a heart transplant if they:
- Don’t respond to:
- Oral medications
- Minimally invasive interventions such as a biventricular pacemaker
- Have difficulty with daily activities due to worsening chest pain, shortness of breath, or arrhythmias
- Experience worsening renal/liver dysfunction
- Need multiple hospital admissions—patients with recurrent hospitalization for heart failure or progressive symptoms are at high risk for death within one year
- Have already had a ventricular assist device (VAD) or left ventricular assist device (LVAD) implanted to temporarily support their heart
Once a patient is referred to a heart transplant program, a multidisciplinary team of specialists will review their case to determine their eligibility and urgency for a transplant.
How Is a Heart Transplant Performed?
A heart transplant requires general anesthesia and usually takes 4–5 hours, though it may take longer, especially if a patient has a left ventricular assist device (LVAD) that needs to be removed.
During transplantation, surgeons place the patient on a heart-lung machine to maintain blood circulation and deliver oxygen to the body. The surgeons then remove the damaged heart and connect the donor heart.
The new heart starts beating once blood flow is restored, which often requires support with medications. Once the surgery is done, the patient is transferred to the intensive care unit. Patients are placed on a breathing tube for 1–3 days and recovery is carefully monitored.
Risks of Heart Transplantation
Heart transplant surgery carries the general risks associated with open chest surgery, including bleeding, stroke, and damage to organs such as the kidneys and liver—although these risks are generally low.
There are specific potential complications early after heart transplant, however, including:
- Primary Graft Dysfunction: This means that the new heart does not start beating and pumping right away. When this occurs, the patient may need to be placed back on the heart-lung machine until the heart recovers. Though it is rare that the heart does not recover, when this happens, a second heart transplant may be needed.
- Acute Rejection: One of most significant risks after heart transplant. The patient’s body (immune system) can reject the donor heart. To prevent this, all transplant recipients receive immunosuppressive medications. At Columbia/NewYork-Presbyterian, we also use heart biopsies and blood tests to monitor that there is no rejection after transplant.
- While rejection is a possibility, some patients never experience rejection and stay on very low doses of immunosuppressive medications.
- Infection: Immunosuppressive medications suppress your immune system to prevent rejection, but they may increase the risk of infection at the same time. Examples of infection include pneumonia, urinary tract infections, and wound infections. Infections are treated with antibiotic therapy.
- Medication Side Effects: Each immunosuppressive medication has its own side-effect profile, such as kidney injuries, electrolyte imbalances, and bone marrow suppression. Medication doses are cautiously managed by the transplant cardiologists, transplant pharmacy, and other consultants in your care.
Wait Time for Transplant
How long someone must wait for a transplant depends on many factors. The sickest patients have first priority and include patients living in the hospital, mostly in the intensive care units, awaiting heart transplants. Patients who are at home on LVADs are next, followed by patients at home on oral heart failure medications. Wait time also depends on a person’s blood type, body size, and whether they have antibodies in their blood that may make finding a donor match more difficult.
Alternatives to Heart Transplantation
There are a variety of advanced and effective treatments that might be alternatives to a heart transplant. Examples of alternatives or options along the pathway to heart transplantation include:
- Heart failure medications, home inotropic therapy
- Biventricular pacemaker, defibrillator
- Transcatheter therapy (coronary stent, transcatheter valve implant)
- Conventional heart surgery (coronary bypass surgery, heart valve repair/replacement)
- LVAD (website link)
- Clinical trials for investigational medical or surgical therapies.
Our heart failure team will explore all of these options to determine what’s the right option for you.
The Heart Transplantation Program at Columbia/NewYork-Presbyterian Hospital
Columbia/NewYork-Presbyterian opened its heart transplant program in 1977 and since then we’ve performed more than 2,500 heart transplants. We currently perform about 60 adult and 30 pediatric heart transplants every year.
Survival after heart transplantation continues to improve, with 93.7 percent one-year survival and 84 percent three-year survival rates. On average, a heart transplant recipient will live more than 12 years after a heart transplant. At Columbia/NewYork-Presbyterian, our outcomes meet or exceed national standards—we have many patients who live 20, 25, and even 30 years after a heart transplant.
Patients with advanced heart failure may also develop irreversible damage to another organ, such as the liver, lungs, or kidneys. As a result, the multidisciplinary care team may recommend dual organ transplantation. Dual organ transplants account for approximately 5 percent of the total number of national heart transplants performed each year. In rare circumstances, a triple organ transplant may be needed.
Patients requiring dual organ transplantation are listed on both organ waiting lists. Wait time for transplantation varies depending on organs needed. Our Columbia/NewYork-Presbyterian specialists for each organ will coordinate a comprehensive care plan to ensure success of each organ transplant. Our dual organ programs are:
Your heart transplant team will educate you about the entire process and work with you to optimize your overall health while you wait for a donor heart. Your team includes:
- Dedicated transplant coordinator
- Transplant surgeons and cardiologists
- Critical care specialists
- Nurses and nurse practitioners
- Physical therapists
- Social workers
- Financial counselors
Once you are listed for a transplant, your heart failure team will follow you as an outpatient. Eventually you may need to be admitted to the hospital, where your team will work together to coordinate your care.
After the transplant, you will be cared for initially in the intensive care unit, where the transplant team will follow you and then move you to the ward to continue recovery.
Your post-transplant team will include a physical therapist, nutritionist, pharmacist, and transplant coordinator to help you learn how to take care of your new heart. After discharge, you will work with our transplant doctors, nurse practitioners, and other specialists, all of whom will make sure that your new heart continues to work well.
Life After a Heart Transplant
Quality of life after heart transplantation may be excellent. Many patients return to work, are able to travel, and, in some circumstances, women with heart transplantations are able to bear children. The goal is to have as normal a life as possible. There are some patients who never return to work and others who continue to require more intensive medical monitoring. Our goal for each patient is to achieve the highest possible quality of life and the longest life possible.
Columbia/NewYork-Presbyterian treats patients with serious high-risk conditions, such as cardiac amyloidosis, diabetes-related end-stage organ damage, and HIV. Despite having more complex patient cases, we consistently achieve excellent patient outcomes. According to the Scientific Registry of Transplant Recipients, our patient survival rate at one year is higher than the national average.