Our Summary

Heart failure is a serious issue worldwide. One way to treat severe heart failure is a heart transplant (HT). In 2020, over 7000 heart transplants were carried out around the world, with 90% of them taking place in the United States or Western Europe, leaving only 10% for the rest of the world. This article looks at HT globally, discussing the challenges and possibilities. The practices, rates, and outcomes of HT vary greatly from country to country. There are several factors limiting the expansion of HT, including cultural beliefs in places like Japan and Israel, lack of funding for healthcare in countries like India and South Africa, unequal access due to socioeconomic status in the United States, and a lack of available organs in China and Saudi Arabia. The article emphasizes the need to overcome these limitations and highlights potential ways to improve worldwide access to HT, especially in countries with lower and middle incomes.

FAQs

  1. How many heart transplants were carried out worldwide in 2020?
  2. What are some of the factors limiting the expansion of heart transplants globally?
  3. What are some potential ways to improve worldwide access to heart transplants?

Doctor’s Tip

One important tip a doctor might tell a patient about heart transplant is to strictly follow their post-transplant medication regimen. This typically includes immunosuppressant drugs to prevent rejection of the new heart. Missing doses or not taking medications as prescribed can increase the risk of rejection and other complications. It is crucial for patients to communicate with their healthcare team if they are experiencing any side effects or difficulties with their medication regimen. Regular follow-up appointments and monitoring are also essential to ensure the success of the transplant.

Suitable For

Patients who are typically recommended for a heart transplant include those with severe heart failure who have not responded well to other treatments such as medications, lifestyle changes, or other surgical procedures. The criteria for heart transplant eligibility may vary slightly from country to country, but generally, patients must meet the following criteria:

  1. Severe symptoms of heart failure, such as shortness of breath, fatigue, and fluid retention, despite optimal medical therapy.
  2. Evidence of severe heart dysfunction, such as a low ejection fraction (the percentage of blood pumped out of the heart with each contraction).
  3. Limited life expectancy without a heart transplant.
  4. Absence of significant organ dysfunction or other medical conditions that would make a heart transplant too risky.
  5. Willingness and ability to comply with the post-transplant care regimen, including taking immunosuppressive medications to prevent rejection.

It is important to note that not all patients with heart failure are eligible for a heart transplant, as the procedure is reserved for those with the most severe cases who are not responding to other treatments. Additionally, the availability of donor organs is a limiting factor in many countries, leading to long waiting times for transplant candidates. efforts are being made to increase organ donation rates and improve access to heart transplants for all eligible patients.

Timeline

Before Heart Transplant:

  1. Patient is diagnosed with severe heart failure and undergoes various treatments such as medications, lifestyle changes, and possibly surgery.
  2. Patient’s condition deteriorates despite treatment, and they are evaluated for a heart transplant by a transplant team.
  3. Patient is placed on the waiting list for a suitable donor heart.
  4. Patient waits for a donor heart, which can take weeks to months depending on availability.
  5. Patient undergoes pre-transplant evaluations and tests to ensure they are a good candidate for the transplant.

After Heart Transplant:

  1. Patient receives a donor heart through a surgical procedure that typically lasts several hours.
  2. Patient is closely monitored in the intensive care unit (ICU) for several days following the transplant.
  3. Patient undergoes a rehabilitation program to help them recover and regain strength.
  4. Patient takes immunosuppressive medications for the rest of their life to prevent rejection of the donor heart.
  5. Patient has regular follow-up appointments with their transplant team to monitor their progress and adjust medications as needed.
  6. Patient gradually resumes normal activities and enjoys improved quality of life with their new heart.

What to Ask Your Doctor

  1. Am I a candidate for a heart transplant? What criteria do I need to meet?
  2. What is the success rate of heart transplants at this hospital or facility?
  3. How long is the waiting list for a heart transplant? What factors determine the waiting time?
  4. What are the risks and potential complications associated with a heart transplant?
  5. How will I be monitored and cared for post-transplant? What is the follow-up care plan?
  6. What lifestyle changes will I need to make after a heart transplant?
  7. What medications will I need to take after the transplant? Are there any potential side effects of these medications?
  8. How long is the recovery period after a heart transplant? What activities should I avoid during this time?
  9. What support resources are available for me and my family before, during, and after the transplant?
  10. What is the long-term outlook for someone who has had a heart transplant?

Reference

Authors: El Rafei A, Cogswell R, Atik FA, Zuckermann A, Allen LA. Journal: Circ Heart Fail. 2025 Jul;18(7):e012272. doi: 10.1161/CIRCHEARTFAILURE.124.012272. Epub 2025 Apr 4. PMID: 40181780