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Frequently asked questions about heart transplantation

Whether you are a transplant recipient or someone who wants to learn more about transplantation, you can find answers to many of your questions by taking a look at the following Frequently Asked Questions (FAQs).

We encourage you to speak with your doctor for more information.

What is transplantation?

Transplantation is the surgical removal of a healthy organ from one person for placement into another person to replace a sick or injured organ.

Organs that can be transplanted include:

Liver
Kidney
Pancreas
Heart
Lung
Intestine

Why is transplantation necessary?

Transplantation is necessary when illness or injury leads to organ failure.

What diseases or conditions commonly lead to heart transplantation?

The most common heart diseases that lead to heart transplantation are ischemic cardiomyopathy and nonischemic cardiomyopathy.

Ischemic cardiomyopathy is when the muscle of the heart wall deteriorates or weakens due to coronary artery disease. As a result, the heart is less able to pump blood efficiently, leading to heart failure.

Nonischemic cardiomyopathy is when the muscle of the heart deteriorates or weakens, but is not due to coronary artery disease. As a result, the ability of the heart to pump efficiently is diminished, leading to heart failure, arrhythmia, and sudden cardiac death.

The possible causes of nonischemic cardiomyopathy are drug and alcohol toxicity, certain infections, and various other unknown causes.

Symptoms of heart disease

The most common symptoms of heart disease are:

Shortness of breath
Increased heart rate or irregular heartbeat
Tiredness, fatigue
Lack of appetite, nausea
Persistent coughing or wheezing
Swelling in different parts of the body
Confusion and/or impaired thinking
Sweating

How is heart disease diagnosed?

If you are experiencing any symptoms of heart disease, contact your doctor immediately. Heart disease can only be detected through medical tests. You and your doctor will work together to decide what tests are necessary for you. These tests may include:

Blood tests
Chest X-rays
Cholesterol screening
Coronary angiography and heart catheterization
Echocardiogram
Electrocardiogram
MRI
Doppler ultrasounds
Ejection fraction
Nuclear stress test
Coronary calcium scans

Once the specific type of heart disease is diagnosed, your doctor will decide which treatment is right for you.

How is heart disease treated?

There are many different types of heart disease. Each disease has a certain type of treatment. In general, most heart diseases can be treated with medications, surgery, and adopting a healthy lifestyle. However, not everyone responds to treatment. If a person develops end-stage heart failure, his or her doctor may recommend a heart transplant.

How will a transplant affect my condition?

A heart transplant is a treatment for heart failure, not a cure. Even after surgery, you may still have the condition that caused your heart to fail. For example, if your heart failed because of coronary artery disease, you will need to continue to take medications to reduce cholesterol levels. If you have high blood pressure, you will need to take medications to control your blood pressure. And you will be instructed to take additional medications after transplant as well as follow a healthy, low-fat diet.

What is the United Network for Organ Sharing (UNOS)?

UNOS is a private, nonprofit organization that matches available organ donors with those awaiting transplant through the national Organ Procurement and Transplantation Network (OPTN). UNOS administers this program under contract with the US Department of Health and Human Services. Members of UNOS include all transplant programs, organizations that find organs, and tissue typing laboratories in the United States.

UNOS guarantees that all persons who need a transplant have an equal opportunity to receive their organs, regardless of age, sex, race, social status, etc. Who gets an available organ is determined by a number of factors, including the length of time a person has been on the waiting list, blood type (A/B/O typing), body size, and health status as determined by UNOS criteria. If you would like to learn more, contact UNOS at 1-888-894-6361.

How is waiting list status determined?

The status of a person awaiting a transplant organ is determined by such factors as severity of disease and time on the waiting list. When a donor organ becomes available, the people for whom that organ is a perfect match are identified, and the organ is offered to the patient who has the most urgent need for the organ, based on his or her current health status. Therefore, the sickest people receive organs before those whose health status will allow them to wait longer for their transplants.

What are antibodies and how will they affect my situation as I wait on the list?

Your immune system produces certain kinds of proteins called antibodies that help protect your body from infectious agents such as viruses. After someone is exposed to an infectious agent and creates antibodies against it, the person is "immune" to the specific disease caused by the infectious agent. The antibodies created are then ready and waiting to destroy the infectious agent if it tries to invade the body again.

The body can also create antibodies against the tissues of other human beings such as that from blood transfusions, pregnancy, or an organ transplant. The antibodies that the body can create after these "sensitizing" events are called anti-human antibodies, or "alloantibodies".

If you have anti-human antibodies in your blood, they may react with the tissue type of the donor, which means that you will not be able to receive a heart from that donor. The antibodies in your blood would attack and damage the heart immediately after transplantation. This is called "hyperacute rejection," which usually results in loss of the transplanted heart. Therefore, you may have to wait longer for a more compatible heart.

In order to prevent hyperacute rejection, panel reactive antibody (PRA) tests or crossmatching is performed before the transplant. If you have a high PRA, you have to wait longer for a more compatible heart. A "positive" crossmatch means that the transplant should not be done because of the high risk for hyperacute rejection. A "negative" crossmatch indicates that it is okay to proceed with the heart transplant.

In certain situations, plasmapheresis may be used to remove antibodies from the blood. Like hemodialysis, plasmapheresis involves circulating part of the patient's blood through a machine. The blood is removed from the body and is centrifuged so that the formed elements of the blood (red blood cells, white blood cells, and platelets) are separated from the liquid part of the blood (the plasma, which contains the antihuman antibodies and other plasma proteins). The plasma is then replaced with another suitable fluid, such as fresh frozen plasma or albumin solution. The formed elements are then
re-suspended in the new fluid and returned to the patient. Immunoadsorption is another technique that can remove antibodies.

How is heart transplantation done?

The healthy heart is obtained from a donor who is brain-dead but has been kept on life support. The heart is then put into a special solution for preservation until the recipient arrives at the hospital.

Following arrival at the hospital and necessary surgical preparations, the transplant team performs one of two surgeries—orthotopic transplantation or heterotopic transplantation.

Orthotopic transplantation

The recipient will first receive general anesthesia
A bypass machine will be hooked to the arteries and veins of the patient so oxygenated blood can keep flowing throughout the body
The surgeon will open the chest cavity of the recipient
The diseased heart will be removed and the donor heart will be put into place
The new heart should start beating after blood flow is restored—an electric shock may be needed

Heterotopic transplantation—“piggyback” transplantation

The recipient will first receive general anesthesia
A bypass machine will be hooked to the arteries and veins of the patient so oxygenated blood can keep flowing throughout the body
The surgeon will open the chest cavity of the recipient
The recipient’s heart and the donor heart are joined (the recipient’s diseased heart is not removed)
The donor heart should start beating once blood flow to the heart is restored
Following surgery, the recipient will be taken to the intensive care unit and carefully monitored by the transplant team.

Does the size of the donated heart matter?

Organ size (which can be affected by gender and weight of donor) is critical in matching a donor heart with a recipient. It is important that the surgeon ensure that your new heart will fit into your chest without pressing against or interfering with other organs and structures in the area.

What are the potential complications of heart transplantation?

It is important to remember that transplantation is a serious surgery and risks still remain. Talk to your transplant team about what you can expect and make sure your concerns are addressed. You should not be surprised if there are some complications following your procedure, as complications following any type of surgical procedure are common. They usually occur within 6 months of transplantation and will be recognized by your doctors. One of the more common complications of transplantation is rejection. However, thanks to anti-rejection drugs, rejection episodes are less common and can be controlled.

Although such medications help prevent rejection, suppression of the immune system also makes transplant recipients more likely to get infections.

In transplanted hearts, the sensory nerves are no longer intact, so there are usually no obvious symptoms that you can feel when there is a problem. This is why people with heart transplants must see their doctor regularly to have their heart biopsied. Often, this is the only way to be certain that rejection or infection is occurring. The following may signal a potential problem:

Fever over 100°F (38°C)
Flu-like symptoms such as chills, nausea, vomiting, diarrhea, tiredness, headache, dizziness, or body aches and pains
Coughing up yellow or green mucus
A dry cough that lasts for more than 1 week
Severe diarrhea
A burning feeling when you urinate
Vaginal discharge or itching
A wound that oozes fluid, does not heal, or feels warm
Swelling, warmth, redness, pain, or tenderness of an arm or leg
Pain or tenderness over your transplant site
Retaining fluids or having sudden weight gain
Shortness of breath
Sudden rise in blood pressure
Change in pulse rate
Tiredness

What can I expect to experience during post-transplant recovery?

You will stay in the hospital for 1 to 2 weeks following surgery. Your doctor will perform frequent biopsies to make sure your body is not rejecting your heart. You will be given a new medication regimen that may include immunosuppressant,
anti-bacterial, anti-viral, and anti-fungal medications.

After you are released from the hospital, you will be closely monitored for about 3 months. During the first few months, you will be very immunosuppressed, which increases your risk of infection. Therefore, it is often recommended that you wear a mask when out in public. If possible, you may even want to avoid large crowds altogether. You can expect to return to a healthy, active life within 3 to 6 months after your surgery, depending on your doctor’s instructions.

What can I expect my physical activity level to be post-transplant?

In the days immediately following your transplant, you can expect to be tired. Heart transplantation is major surgery. However, you will begin to feel better and stronger each day.

Exercise according to your transplant team’s instructions, generally at least 5 days a week. Increase your time and pace slowly to reach a minimum of 30 minutes a day. Pace yourself because your transplanted heart won’t react as quickly to physical activity as a normal heart does.

Will my new heart act the same way as my old one?

Your heart will react differently to physical activity after transplant. This is because the nerves that connected your original heart to your nervous system were cut during the transplant surgery (denervated). Because these nerves will not heal, your heart cannot respond immediately to exercise, sudden movement, or emotional stress like fear. It does react, but not nearly as fast. It may take some time to get used to how your new heart responds.

Will I need to weigh myself, take my temperature, or take my blood pressure after surgery?

As part of your post-transplant care, you will have to weigh yourself daily. Rapid weight gain can be a sign that your heart is not pumping efficiently. If you gain more than 2 to 3 pounds in one day or more than 3 to 5 pounds in one week, call your transplant coordinator or cardiologist.

Your transplant team will also instruct you to take your temperature 3 times a day (morning, afternoon, and evening). A fever can be one of the first signs of infection. You may also be asked to measure your blood pressure to ensure that your heart is pumping blood through your body efficiently.

When preparing for your surgery, make certain that you have a scale, thermometer, and blood pressure cuff at home. These items may be given to you by your transplant coordinator.

What medications will I have to take post-transplant?

To help ensure your transplant is a success, your doctor will prescribe several different medications to slow down your body's immune system and make your body less likely to reject your transplanted organ. This process is called immunosuppression.

Although your doctor will work to prevent rejection, it can still occur. If you experience a rejection episode, your doctor may decide to treat it with different or additional medications, or simply with a dose adjustment of the medication or medications that you are already taking.

Your biggest responsibility post-transplant is keeping your organ, and yourself, healthy. Proper adherence to your regimen is critical to your long-term health.

Because some medications may produce unwanted side effects, it is important that you ask questions and talk freely with your transplant team about how you are feeling.

Medications commonly used in transplantation include:

What is Prograf^® (tacrolimus)?

Prograf is an immunosuppressant approved for the prevention of rejection in people who have received a liver, kidney, or heart transplant. Anti-rejection medications like Prograf are essential to the success of transplantation. In fact, since approval for rejection prevention for liver transplantation in 1994, for kidney transplantation in 1997, and for heart transplantation in 2006, Prograf has helped many people live each day with confidence. Read Prograf and You to learn more about what Prograf can do for you.

Important Safety Information About Prograf^®

Prograf^® (tacrolimus) is approved for the prevention of rejection in patients who have received a liver, kidney, or heart transplant. Only physicians and facilities specializing in transplantation should manage patients taking Prograf. Anti-rejection medications may result in an increased possibility of developing an infection or lymphoma, a type of cancer.

In clinical studies, up to 22% of patients taking Prograf developed insulin-dependent diabetes after transplant, but in some patients, after two years, insulin was no longer required. Black and Hispanic kidney transplant patients were at an increased risk.

Prograf has been associated with toxicity to the kidneys and nervous system. Common side effects are tremor, headache, insomnia, high blood pressure, diarrhea, nausea, constipation, stomach pain, changes in kidney function, high blood sugar, low white cell count, infection, and high cholesterol/lipid levels.

Prograf should not be used in patients allergic to tacrolimus. Prograf injection should not be used in patients allergic to castor oil.

Only your healthcare professional can weigh the risks and benefits of a prescription medication and decide which medication is the right one for you.

Please see the full prescribing information.

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