Heart Transplant: What to Expect
A complete health evaluation is necessary to determine whether transplant surgery is appropriate for you. Typically, you’ll need three or four days of testing on an outpatient basis for evaluation. This evaluation may take place as an inpatient if your illness is severe.
If the transplant physician finds that transplantation is an appropriate option, and if you want to receive a heart transplant, you will be placed on the transplant waiting list. Your name, blood type, body size, and status criteria will be placed in the national United Network for Organ Sharing (UNOS) computer. You will need to carry a cellphone or beeper to be contacted quickly when a donor becomes available. You will receive written notification when you are activated on the heart transplant waiting list.
Your status awaiting a heart transplant is determined by how ill you are:
- A status of 2 indicates you are stable and can wait at home.
- Status 1B means you are more ill and might be dependent on IV medication (inotropes) to assist the heart. Status 1B patients can sometimes wait in the community instead of the hospital.
- Status 1A means you are dependent on a mechanical device such as a balloon pump or a left ventricular assist device, often referred to as an LVAD. You’re probably also on two IV medications, in addition to hemodynamic monitoring in the intensive care unit (ICU). Status 1A patients are considered critical and will be transplanted before Status 1B patients as long as blood type and size are appropriate.
While waiting for a transplant, you must live within two hours of the hospital so you can arrive soon after a donor becomes available. You should also notify the transplant office if you are admitted to another hospital or if you develop any serious infections such as pneumonia or abscesses.
The length of time you wait for surgery varies depending on donor availability, your blood type, body size, and how sick you are. The waiting time for a transplant is commonly several months because of the shortage of donor organs.
You will be called when an appropriate donor heart is ready. You should not eat or drink anything after getting called, and you must arrive at the hospital within two hours. You’ll be admitted to UT Southwestern Medical Center's William P. Clements Jr. University Hospital, and blood work will be drawn immediately. Other preparatory procedures such as a chest X-ray and showers with special antibacterial soap will also be done. Most patients are in surgery within a few hours.
During surgery, your family will be directed to a waiting room and an operating room nurse will update them during the surgery. The surgeon will meet with your family once the surgery is completed.
Heart transplant surgery usually takes four to six hours. Your heart will not be removed until the new heart arrives in the operating room.
Once surgery is finished, you will spend an average of three to four days in the Cardiovascular Intensive Care Unit (CVICU). For your protection, all visitors and health care personnel will wear gowns, gloves, and masks when in your room in the CVICU.
Once you are breathing safely on your own and the new heart is functioning well, you will be transferred out of the CVICU. Patients generally spend another five to seven days in the hospital. During this time, you'll learn about medications, future outpatient visits, and general health care issues. You will also undergo physical therapy and learn how to take care of your new heart.
The first two to three months after the transplant are the most critical. This is the most common time for infection and rejection to occur. You’ll need to come to the transplant office twice a week at first, so it’s necessary for you to remain in the Dallas area for at least six to 12 weeks, depending on how far your home is from the Metroplex.
A heart transplant requires a long-term commitment, as you will need to take medications for the rest of your life; exercise regularly; eat a healthy diet; abstain from smoking, street drugs, and alcohol; and have frequent medical checkups. The UT Southwestern transplant team can help you take care of your new heart.