Our Summary

This research paper is about updated guidelines for the evaluation and care of people who need a heart transplant. These guidelines replace previous ones from 2006 and 2016. The new guidelines help doctors consider many factors when deciding who should get a heart transplant. They stress the importance of team-based care while a patient waits for a transplant.

Since the last guidelines, there have been some important changes in how we care for people who have had a heart transplant. These changes relate to who should be selected for a transplant, how to care for specific groups of patients, and how to use mechanical support for the heart.

Three groups of experts were brought together to address these issues. Each group was led by a doctor who specializes in heart transplants in children, to make sure the unique issues in this group were properly addressed.

The new guidelines have been made to match up with other guidelines from the same organization, up to November 2023. They offer advice based on the most recent scientific evidence and provide diagrams to help manage patient care.

They have also been organized according to a format used by the American College of Cardiology and the American Heart Association. This format breaks down information into small, manageable sections based on specific topics or issues.

These guidelines aim to improve the quality of care for people who need a heart transplant by providing an approach based on the best available evidence.

FAQs

  1. What are the main changes in the updated guidelines for heart transplant evaluation and care compared to the previous ones from 2006 and 2016?
  2. How do the new guidelines ensure the care and consideration of specific groups of patients, like children, who need a heart transplant?
  3. How do these guidelines correlate with those from the American College of Cardiology and the American Heart Association?

Doctor’s Tip

A helpful tip a doctor might tell a patient about heart transplant is to follow a strict medication regimen to prevent rejection of the new heart. It is important to take your medications exactly as prescribed and to never skip doses. Missing doses can increase the risk of rejection and other complications. Always talk to your doctor before making any changes to your medication routine.

Suitable For

Patients who are typically recommended for a heart transplant include those with end-stage heart failure who have not responded well to other treatments such as medication, lifestyle changes, or surgical interventions. These patients may have severe symptoms, such as shortness of breath, fatigue, and fluid retention, that significantly impact their quality of life and daily functioning.

In addition, patients who have a life expectancy of less than 1 year without a transplant, as determined by their medical team, are also candidates for a heart transplant. These patients may have advanced heart failure that is not responsive to other therapies and are at high risk of sudden cardiac death.

It is important to note that not all patients with end-stage heart failure are suitable candidates for a heart transplant. Factors such as age, overall health, presence of other medical conditions, and ability to comply with post-transplant care regimens are all taken into consideration when evaluating a patient for a heart transplant.

Ultimately, the decision to recommend a heart transplant for a patient is made by a multidisciplinary team of healthcare professionals, including cardiologists, cardiac surgeons, transplant coordinators, social workers, and mental health professionals. This team works together to assess the patient’s overall health and determine the best course of treatment for their individual needs.

Timeline

Before a heart transplant, a patient typically goes through a thorough evaluation process to determine if they are a suitable candidate for the procedure. This evaluation includes medical history, physical exams, blood tests, imaging tests, and psychological evaluations. The patient may also need to undergo additional tests to assess the function of their heart and other organs.

After being listed for a heart transplant, the patient will need to wait for a suitable donor heart to become available. During this waiting period, the patient will be closely monitored and may need to make lifestyle changes to improve their overall health. They may also need to receive mechanical support for their heart if it is not functioning properly.

Once a donor heart becomes available, the patient will undergo the heart transplant surgery. After the surgery, the patient will need to stay in the hospital for monitoring and recovery. They will need to take medications to prevent rejection of the new heart and will need to attend regular follow-up appointments with their medical team.

Overall, the process of receiving a heart transplant involves a comprehensive evaluation, waiting for a donor heart, undergoing surgery, and then receiving ongoing care and monitoring to ensure the success of the transplant.

What to Ask Your Doctor

  1. What criteria do you use to determine if I am a candidate for a heart transplant?
  2. How long is the waiting list for a heart transplant and what can I do to optimize my chances of receiving a donor heart?
  3. What are the potential risks and complications associated with a heart transplant surgery?
  4. How will I be monitored and cared for after the transplant surgery?
  5. What lifestyle changes will I need to make post-transplant to ensure a successful outcome?
  6. How often will I need to follow up with you after the transplant surgery?
  7. Are there any medications I will need to take for the rest of my life after the transplant?
  8. How will the transplant surgery and recovery process impact my daily activities and quality of life?
  9. What support resources are available for me and my family as I go through this process?
  10. Are there any alternative treatment options to consider before pursuing a heart transplant?

Reference

Authors: Peled Y, Ducharme A, Kittleson M, Bansal N, Stehlik J, Amdani S, Saeed D, Cheng R, Clarke B, Dobbels F, Farr M, Lindenfeld J, Nikolaidis L, Patel J, Acharya D, Albert D, Aslam S, Bertolotti A, Chan M, Chih S, Colvin M, Crespo-Leiro M, D’Alessandro D, Daly K, Diez-Lopez C, Dipchand A, Ensminger S, Everitt M, Fardman A, Farrero M, Feldman D, Gjelaj C, Goodwin M, Harrison K, Hsich E, Joyce E, Kato T, Kim D, Luong ML, Lyster H, Masetti M, Matos LN, Nilsson J, Noly PE, Rao V, Rolid K, Schlendorf K, Schweiger M, Spinner J, Townsend M, Tremblay-Gravel M, Urschel S, Vachiery JL, Velleca A, Waldman G, Walsh J. Journal: J Heart Lung Transplant. 2024 Oct;43(10):1529-1628.e54. doi: 10.1016/j.healun.2024.05.010. Epub 2024 Aug 8. PMID: 39115488