Heart Transplant

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Introduction

Heart Transplant

A heart transplant is an operation to replace a damaged or failing heart with a healthy heart from a donor who has recently died.

It may be recommended when a person's life is at risk because their heart no longer works effectively.

This page covers:

Why they're carried out

What happens

Recovery

Risks

Outlook

Why heart transplants are carried out

A heart transplant may be considered if you have severe heart failure and medical treatments aren't helping.

Conditions that may eventually require a heart transplant include:

  • coronary heart disease - a build-up of fatty substances in the arteries supplying the heart, which block or interrupt blood flow to the heart
  • cardiomyopathy - where the walls of the heart have become stretched, thickened or stiff
  • congenital heart disease - birth defects that affect the normal workings of the heart

If your doctor thinks you might benefit from a heart transplant, you'll need to have an in-depth assessment to check whether you're healthy enough to have one before being placed on a waiting list.

Read more about who can have a heart transplant and being on the heart transplant waiting list.

What happens during a heart transplant

A heart transplant needs to be carried out as soon as possible after a donor heart becomes available.

The procedure is performed under general anaesthetic (where you're asleep).

While it's carried out, a heart-lung bypass machine will be used to keep your blood circulating with oxygen-rich blood.

A cut is made in the middle of the chest. Your own heart is then removed, and the donor heart is connected to the main arteries and veins. The new heart should then begin beating normally.

Read more about how a heart transplant is performed.

Recovering from a heart transplant

You'll usually need to stay in hospital for around two or three weeks after a heart transplant. Most people are able to start returning to many of their normal activities within a few months.

Your transplant team can give you advice about how long you may need to avoid certain activities during your recovery.

You'll need to have regular check-ups with your transplant team after the transplant.

You'll also need to take medications called immunosuppressants for the rest of your life. Without these medicines, your body may recognise your new heart as foreign and attack it (known as rejection).

Read more about recovering from a heart transplant.

Risks of a heart transplant

A heart transplant is a complex and risky procedure.

Possible complications include:

  • the immune system recognising the transplanted heart as foreign and attacking it (rejection)
  • the donated heart fails to work properly (graft failure)
  • narrowing of the arteries supplying the heart (cardiac allograft vasculopathy)
  • side effects from the immunosuppressant medication, such as an increased vulnerability to infections, weight gain and kidney problems

Many of these problems are treatable, although sometimes another heart transplant may need to be carried out if possible.

Read more about the risks associated with a heart transplant.

Outlook for heart transplants

Most people can eventually return to their normal activities after a heart transplant and experience a significant improvement in their symptoms for many years.

However, it's a major operation and some of the complications can be life threatening.

Overall:

  • 80-90 in every 100 people will live at least a year
  • 70-75 in every 100 people will live at least five years
  • 50 in every 100 people will live at least 10 years

Some people have survived for more than 25 years after a heart transplant.

Who-can-have-one

Who can have one

As donor hearts are scarce, you'll need to be assessed carefully to determine whether a heart transplant is suitable, if your doctor thinks you could benefit from one.

When heart transplants are considered

A heart transplant may be considered if:

  • you have significant heart failure, where the heart is having trouble pumping enough blood around the body - usually the result of coronary heart disease, cardiomyopathy or congenital heart disease
  • you have severe symptoms, despite medical treatment
  • you could die within the next few years if you don't get a transplant
  • you're otherwise fit enough to survive major surgery

If it's thought you could benefit from a heart transplant, you'll be assessed at a transplant centre to check whether having one is suitable.

Assessment for a heart transplant

An in-depth assessment at a transplant centre is needed to find out more about your health and check whether there are any underlying problems that could affect your suitability for a transplant.

This will usually involve having several tests, such as:

You'll also have the opportunity during your assessment to meet the transplant team and find out more about the procedure.

You may find it useful to write down a list of questions you would like to ask the transplant team before your visit.

Who might not be suitable for a heart transplant

Unfortunately, not everyone who could benefit from a heart transplant will be suitable for one.

This is because the operation places a major strain on the body, and may mean the risks outweigh the potential benefits.

For example, you may be considered unsuitable for a heart transplant if you:

  • have irreversible damage to other organs, such as your kidneys
  • have an active infection - this will need to be treated first, if possible
  • have cancer - treatment to bring it under control (known as being in remission) will usually be needed before a transplant is considered
  • have damaged blood vessels as a result of diabetes
  • are obese - you may need to lose weight before a transplant is considered
  • drink alcohol excessively or smoke - you may need to stop before a transplant is considered

Age isn't a factor in determining whether a heart transplant is suitable, although they're rarely performed in people over the age of 65 because they often have other health problems that mean a transplant is too risky.

Decision to recommend a transplant

The final decision about whether you are suitable for a heart transplant is a joint decision made by the transplant team.

You may be informed about the decision before leaving the transplant centre. But if your case is not straightforward, it may be several weeks before you are told the decision.

The transplant team may decide you are:

  • suitable for a transplant and ready to be placed on a waiting list - read more about being on the heart transplant waiting list
  • suitable for a transplant, but your condition does not require a transplant - you will usually be monitored in case your condition gets worse
  • unsuitable for a transplant - the reasons will be explained in detail by your transplant team

In some cases, further tests are necessary to make a final decision, or you may be referred to a different transplant centre for a second opinion.

Waiting-list

Waiting list

Because of the lack of available hearts, it's rarely possible to have a heart transplant as soon as it's needed, so you'll usually be placed on a waiting list.

It may be several months, or possibly years, before a donor heart of the right size and blood group becomes available.

Many people are well enough to stay at home until a heart becomes available, although some people will need to remain in hospital.

The transplant centre can offer support, guidance and information while you wait for a suitable donor to be found. They will be fully aware that many people find this a frustrating and frightening experience.

Waiting for a suitable donor

While waiting for a donated heart to become available, it's important to stay as healthy as possible by:

The transplant centre will need to be able to contact you at short notice, so you should inform staff if your contact details change.

You should also let staff know if your health changes - for example, if you develop an infection.

Prepare an overnight bag and make arrangements with your friends, family and employer so you can go to the transplant centre as soon as a donor heart becomes available.

Coping with being on the waiting list

Living with a serious heart condition can be strenuous enough, and the added anxiety of waiting for a heart to become available can make the situation even more difficult.

This can have an effect on both your physical and mental health. Contact your GP or the transplant centre for advice if you're struggling to cope emotionally with the demands of waiting for a transplant.

You may also find it useful to contact a support group, such as the British Heart Foundation or Little Hearts Matter, a charity for children with heart defects.

Getting the call

When a suitable donor heart is found, the transplant centre will contact you and ask you to go to the centre.  

When you hear from the transplant centre:

  • do not eat or drink anything
  • take all current medicines with you
  • take a bag of clothes and essentials for your hospital stay

At the transplant centre, you'll be reassessed quickly to make sure no new medical conditions have developed.

When the medical team has confirmed that you and the donor heart are suitable, you will be given a general anaesthetic.

The procedure must be carried out as quickly as possible to have the best chance of success.

Read more about what happens during a heart transplant.

Transplant centres

Heart transplants are carried out at a specialist heart transplant centre.

UK heart transplant centres are located in:

Surgery

What happens

A heart transplant is carried out with you unconscious under general anaesthetic, and normally takes between four and six hours.

You'll be connected to a heart-lung bypass machine, which will take over the functions of the heart and lungs while the transplant is being carried out.

A thin, flexible tube called a catheter will also be inserted to drain your bladder during and after the operation.

During the procedure:

  • a cut (incision) is made down your chest over your breastbone and the bone is separated, allowing the surgeon to access your heart
  • your heart is removed, leaving behind a section of the right and left atria, the two upper chambers of the heart
  • the new heart is connected to the aorta, the main artery from the heart, the pulmonary artery, and the remaining part of the atria

You'll be taken off the bypass machine when your new heart starts beating.

Your breastbone will be closed with metal wires, and the tissues and skin will be closed with stitches.

After the operation

Once the transplant is complete, you'll be moved to an intensive care unit (ICU).

A machine called a ventilator will assist you with your breathing, and a tube will be inserted into a vein to provide you with fluid and nutrients. These will normally be removed after a few days.

You'll also be given pain relief as required.

Most people are well enough to move from the ICU and into a hospital ward within a few days.

You'll usually be able to leave hospital within two or three weeks, although you'll need to have regular follow-up appointments and take medication to help stop your body rejecting your new heart.

Read more about living with a heart transplant.

Recovery

Living with

Most people can eventually return to their normal activities after a heart transplant, although it may be a few months before you feel up to it.

See below for information and advice about:

Follow-up appointments

Immunosuppressants

Exercise

Diet

Smoking and alcohol

Sex, pregnancy and contraception

Driving, travel and work or school

Follow-up appointments

You'll have regular follow-up appointments to monitor your progress after a heart transplant.

These will be quite frequent at first, but may eventually only be necessary once every few months, or possibly even once a year.

During these appointments, you will have tests to check how well your heart and medication are working, and to check for any complications of a heart transplant.

Immunosuppressants

You'll need to take several medications called immunosuppressants for the rest of your life after having a heart transplant.

Without these medicines, your body may recognise your new heart as foreign and attack it. This is known as rejection.

Immunosuppressants are powerful medications that can have a range of significant side effects, such as an increased vulnerability to infection, weak bones (osteoporosis), kidney problems and diabetes.

While these side effects may be troublesome, you should never stop taking your immunosuppressants without medical advice. If you do, it could lead to your heart being rejected.

Read more about immunosuppressant side effects.

Exercise

You'll usually receive support from a physiotherapist while you're still in hospital to help you get around and build up your strength.

You'll also be encouraged to take part in a cardiac rehabilitation programme after going home. This involves following a personalised exercise plan to help you regain your previous strength and mobility.

You can return to gentle exercise when you're feeling up to it. Avoid strenuous activities such as pushing, pulling or lifting anything heavy for at least 6 to 12 weeks.

You may eventually be able to take part in contact sports and more extreme activities such as marathon running or mountain climbing, but you should always get advice from your transplant team first.

Diet

You don't usually need to have a special diet after a heart transplant. A generally balanced diet can help with healing and ensure you stay as healthy as possible.

A healthy diet may also help reduce the risk of some of the side effects of immunosuppressants, including weight gain, osteoporosis and diabetes.

Immunosuppressants also make you more vulnerable to infections, including food poisoning. Make sure you practise good food hygiene to reduce your risk of getting a tummy bug.

Smoking and alcohol

Smoking can be very harmful, so you'll usually be advised to stop or avoid smoking after a heart transplant.

Read more advice and information about stopping smoking.

You can still drink alcohol after a heart transplant, although you should avoid drinking excessive amounts. Try to avoid regularly drinking more than 14 units of alcohol a week.

Sex, pregnancy and contraception

Speak to your transplant team if you want to try for a baby after having a heart transplant.

They will talk to you about the possible risks, any extra care you might need, and any possible changes to your medication.

You may be advised to wait until at least a year after your transplant operation before trying for a baby.

If you're not trying for a baby, speak to your transplant team about appropriate contraception, as some types of contraceptive pill can interfere with your immunosuppressant medication.

Even if you're taking the pill, it's a good idea to ensure you or your partner use a barrier method of contraception, such as a condom, because you're at an increased risk of sexually transmitted infections (STIs).

Driving, travel and work or school

You'll need to stop driving for at least a month after a heart transplant, and you may not be able to start again for 6 to 12 weeks. Ask your transplant team for advice about when it's safe to drive.

Many people can return to work after a heart transplant, but how long it takes depends on your job and how well you recover. Most people return to work within six months.

Children who've had a heart transplant may be able to return to school within two or three months.

You can travel after a heart transplant, but it might be a good idea to wait until the first year of frequent follow-up appointments has finished. Speak to your transplant team for more advice on travelling.

Risks

Risks

A heart transplant is a major operation, and there is a risk of several complications.

Some complications can occur soon after the procedure, while others may develop months or even years later.

The main risks associated with a heart transplant are described below.

Rejection

One of the most common complications of a heart transplant is rejection of the donor heart. This is where the immune system recognises the transplanted heart as foreign and attacks it.

Rejection usually occurs in the days, weeks or months after the transplant, although it can sometimes happen years later.

Immunosuppressant medication can reduce the risk of this happening, but can't always prevent it completely.

Symptoms of rejection can include:

Contact your GP or transplant team as soon as possible if you have these symptoms. Rejection can usually be treated by increasing your dose of immunosuppressant medication.

Graft failure

One of the most serious complications that can occur soon after a heart transplant is that the donated heart fails and doesn't work properly.

This is known as graft failure, or primary graft dysfunction. It occurs in 5-10% of people who've had a heart transplant, and can be fatal.

You'll be closely monitored after your transplant to check for signs of graft failure so treatment can be started as soon as possible.

Treatments for graft failure include:

  • using medications to support the new heart
  • using a breathing machine (ventilator) to help oxygen reach the blood
  • using a mechanical device (ventricular assist device) that takes over the work of the new heart
  • using a bypass machine to keep your circulation working until the new heart improves

Some people with graft failure may need to go on the waiting list for another heart transplant if they're otherwise well enough to have the procedure again.

Immunosuppressant side effects

The immunosuppressant medications you need to take to prevent rejection can have a number of significant side effects.

These can include:

Speak to your transplant team if you experience any troublesome side effects. Don't stop taking your medication without getting medical advice first.

Infections

Immunosuppressant medication will weaken your immune system and make you more vulnerable to infection.

While taking the medication, it's a good idea to:

  • report any possible symptoms of an infection to your GP or transplant team immediately - things to look out for include a high temperature (fever), aching muscles, diarrhoea or headaches
  • ensure your vaccinations are up-to-date - speak to your GP or transplant team for advice about any additional vaccines you might need, as some aren't safe if you have a weak immune system
  • avoid close contact with anyone who has an infection - even if it's an infection to which you were previously immune, such as chickenpox

To help prevent infection, you may be given antibioticsantifungal medicine or antiviral medication to take for at least the first few weeks or months after your transplant.

Narrowed arteries

Narrowing and hardening of the blood vessels connected to the donor heart is a common long-term complication of a heart transplant.

The medical term for this complication is cardiac allograft vasculopathy (CAV). It tends to occur several years after the transplant operation.

CAV is potentially serious as it can restrict the supply of blood to the heart, which can sometimes trigger a heart attack or lead to a recurrence of heart failure.

It's therefore recommended you have regular coronary angiographies - a type of X-ray used to study the inside of your heart - to check your heart is receiving enough blood.

Medications can help keep CAV under control if it does develop, but the only cure is to have another heart transplant.

'I returned to work as a gardener 13 weeks after the transplant'

'I returned to work as a gardener 13 weeks after the transplant'

In 1998, Andy Cook was told he had just two days to live. But when a donor heart became available, a transplant saved his life. He now works full time in an outdoor job he loves, and travels the world to meet other transplant recipients.

Andy, from Halesowen in the Midlands, was 37 when he developed cardiomyopathy, a disease that causes the heart to become enlarged.

"I had a cough that my doctor couldn't cure and, after several visits, I became more and more short of breath," Andy says.

"I was admitted to the Wordsley Hospital in Stourbridge, where I was diagnosed as having fluid on the chest that was affecting my heart. A little later, I was told I had cardiomyopathy."

Six days after he was admitted to hospital, Andy had two heart attacks. He was treated, but his condition got worse and he was sent to Queen Elizabeth Hospital in Birmingham for a transplant assessment.

His consultant told him that he needed a transplant, and he was put on the transplant list and sent back to the Wordsley to wait.

"Over the next few weeks, my condition worsened and the need for a donor heart became more desperate. My weight plunged from 11 stone to just 7."

With time running out, a donor heart became available, and Andy was transferred back to the Queen Elizabeth Hospital.

"The last thing I remember before the operation was the needle being put into the back of my hand. When I woke up, I was being transferred from intensive care to a ward after two days of sedation."

Bit by bit, Andy regained his strength, but his journey back to health had some setbacks.

"After I had been allowed home, I spent the next six weeks in and out of hospital with rejection, a stomach problem, a collapsed lung and another related problem.

"I finally came out of hospital the week before Christmas 1998, and returned to work as a gardener 13 weeks after the transplant.

"I genuinely believe that if you follow medical advice, you will be back to your previous fitness and way of life. I am very grateful for all the help and treatment I received."