Our Summary

The number of people with heart failure is increasing, but the number of available donor hearts is not. Therefore, doctors need to carefully choose who gets a heart transplant. They need to consider many factors in order to make sure the patient will benefit from the transplant and that the valuable donor heart is used well. Recent research has helped create ways to better assess the risk for potential heart transplant patients, considering both heart-related and non-heart-related factors. These new methods can help doctors weigh up the risks and benefits of a heart transplant, given the limited number of donor hearts. The main aim of a heart transplant is to help the patient live longer and improve their quality of life. To achieve this, doctors need to thoroughly assess the patient, considering their overall health, other medical conditions, and mental and social factors. The best way to select patients for heart transplants involves using these new risk-assessment methods alongside a detailed examination of the patient’s health and circumstances.

FAQs

  1. What factors are considered when selecting a candidate for a heart transplant?
  2. How does recent research help in risk assessment for heart transplant candidates?
  3. What is the main goal of heart transplantation and how is it achieved?

Doctor’s Tip

One helpful tip a doctor might tell a patient about heart transplant is to closely follow all post-transplant care instructions, including taking prescribed medications, attending follow-up appointments, and making lifestyle changes such as maintaining a healthy diet and regular exercise routine. Adhering to these recommendations can help ensure the success of the transplant and improve long-term outcomes.

Suitable For

Patients who are typically recommended for heart transplant are those who have advanced heart failure that is not responding to other medical therapies, have a poor prognosis without transplantation, and have no contraindications to surgery. These patients may have severe symptoms such as shortness of breath, fatigue, and fluid retention, as well as evidence of advanced heart damage on imaging tests. Additionally, patients must have a good understanding of the risks and benefits of transplantation, be willing and able to comply with post-transplant medication and lifestyle requirements, and have a strong support system in place. Patients with certain comorbidities, such as severe kidney or liver disease, may not be candidates for heart transplant. Overall, the decision to recommend heart transplant is individualized and based on a thorough evaluation of each patient’s specific circumstances.

Timeline

Before heart transplant:

  1. Diagnosis of end-stage heart failure: Patients may experience symptoms such as shortness of breath, fatigue, swelling in the legs, and difficulty performing daily activities.
  2. Evaluation by a cardiologist: The patient undergoes various tests and assessments to determine the severity of heart failure and eligibility for a heart transplant.
  3. Placement on the transplant waiting list: Once deemed eligible, the patient is placed on the national transplant waiting list and awaits a suitable donor heart.
  4. Monitoring and management of symptoms: Patients may undergo treatments such as medication, lifestyle changes, and potentially mechanical circulatory support devices to manage their heart failure symptoms and improve their overall health.

After heart transplant:

  1. Surgery and recovery: The patient undergoes a heart transplant surgery, during which their diseased heart is replaced with a healthy donor heart. Recovery typically involves a hospital stay and rehabilitation.
  2. Immunosuppressive therapy: Patients must take medications to suppress their immune system and prevent rejection of the transplanted heart. These medications are taken for life.
  3. Follow-up care: Patients require regular follow-up appointments with their transplant team to monitor their heart function, medication levels, and overall health.
  4. Lifestyle changes: Patients are encouraged to make healthy lifestyle choices, such as maintaining a balanced diet, exercising regularly, and avoiding smoking and excessive alcohol consumption.
  5. Improved quality of life: Many patients experience improved quality of life post-heart transplant, with fewer symptoms and the ability to engage in activities they were previously unable to do.

What to Ask Your Doctor

  1. Am I a candidate for a heart transplant?
  2. What criteria do I need to meet in order to be considered for a heart transplant?
  3. What are the risks and benefits of a heart transplant for me specifically?
  4. What is the success rate of heart transplants at this facility?
  5. How long is the waiting list for a donor heart?
  6. What is the recovery process like after a heart transplant?
  7. What medications will I need to take after the transplant?
  8. What lifestyle changes will I need to make after the transplant?
  9. What are the potential complications or risks associated with a heart transplant?
  10. Are there any alternative treatments or therapies that I should consider before opting for a heart transplant?

Reference

Authors: Mantha A, Lee RO Jr, Wolfson AM. Journal: Curr Opin Organ Transplant. 2022 Feb 1;27(1):36-44. doi: 10.1097/MOT.0000000000000943. PMID: 34939963