Definition
Organ transplantation is the moving of an organ from one body to another or from a donor site to another location on the person's own body, to replace the recipient's damaged or absent organ. The emerging field of regenerative medicine is allowing scientists and engineers to create organs to be re-grown from the person's own cells (stem cells, or cells extracted from the failing organs). Organs and/or tissues that are transplanted within the same person's body are called auto grafts. Transplants that are recently performed between two subjects of the same species are called allograft. Allograft can either be from a living or cadaveric source.
Organs that can be transplanted are the heart, kidneys, liver, lungs, pancreas, intestine, and thymus. Tissues include bones, tendons (both referred to as musculoskeletal grafts), cornea, skin, heart valves, nerves and veins. Worldwide, the kidneys are the most commonly transplanted organs, followed by the liver and then the heart. Cornea and musculoskeletal grafts are the most commonly transplanted tissues; these outnumber organ transplants by more than tenfold.
Organ donors may be living, brain dead, or dead via circulatory death. Tissue may be recovered from donors who die of circulatory death, as well as of brain death – up to 24 hours past the cessation of heartbeat. Unlike organs, most tissues (with the exception of corneas) can be preserved and stored for up to five years, meaning they can be "banked". Transplantation raises a number of bioethical issues, including the definition of death, when and how consent should be given for an organ to be transplanted, and payment for organs for transplantation. Other ethical issues include transplantation tourism and more broadly the socio-economic context in which organ procurement or transplantation may occur. A particular problem is organ trafficking. Some organs, such as the brain, cannot be transplanted.
Transplantation medicine is one of the most challenging and complex areas of modern medicine. Some of the key areas for medical management are the problems of transplant rejection, during which the body has an immune response to the transplanted organ, possibly leading to transplant failure and the need to immediately remove the organ from the recipient. When possible, transplant rejection can be reduced through stereotyping to determine the most appropriate donor-recipient match and through the use of immunosuppressant.
Brief History
Successful human allotransplant have a relatively long history of operative skills that were present long before the necessities for post-operative survival were discovered. Rejection and the side effects of preventing rejection (especially infection and nephropathy) were, are, and may always be the key problem.
Several apocryphal accounts of transplants exist well prior to the scientific understanding and advancements that would be necessary for them to have actually occurred. The Chinese physician Pien Chi'ao reportedly exchanged hearts between a man of strong spirit but weak will with one of a man of weak spirit but strong will in an attempt to achieve balance in each man. Roman Catholic accounts report the 3rd-century saints Damian and Cosmas as replacing the gangrenous or cancerous leg of the Roman deacon Justinian with the leg of a recently deceased Ethiopian. Most accounts have the saints performing the transplant in the 4th century, many decades after their deaths; some accounts have them only instructing living surgeons who performed the procedure.
Transplanting organs, replacing old worn-out organs with healthier ones, has long been a dream in medicine. Several attempts were made in 1901 in Vienna, where investigators tried to transplant kidneys in dogs, pigs, goats, and calves. The exercise turned out to be purely technical due to the lack of understanding of vascular surgical techniques, organ preservation, and immunosuppressant. In 1902, Dr. Alexis Carrel developed the technique of vascular suturing that in principle is still in practice today. Dr. Carrel developed the technique when, in his attempts at transplanting kidneys to the neck of dogs, he found that the organs thrombosed. Believing that the transplants failed due to a simple technical problem, he developed the vascular surgical technique. Thanks to Dr. Carrel, vascular surgery began to develop, but transplantation still had a long way to go.
In 1933, the first real attempt at transplanting a human kidney to a human patient was done by Dr. YuYu Voronoy in Russia. A kidney was taken from a recently deceased individual and connected to a young woman who was suffering from lead poisoning. No immunosuppressant was given. The kidney never functioned. In 1948, Sir Peter Medawar performed experiments that for the first time defined the immunology of transplantation and began to define rejection. For his pioneering work in transplant immunology, Dr. Medawar received the Nobel Prize in Medicine in 1958.
In the early 1950s, Dr. Rene Küss in Paris and Dr. David Hume in Boston began earnest attempts at transplantation. The first recorded event in which a transplanted kidney functioned was in 1951. Dr. Küss transplanted the kidney to the iliac fossa, as is done today. One of the 5 transplanted kidneys worked for 2 months without immunosuppressant, when it rejected and thrombosed. In contrast, Dr. Hume placed 6 kidneys subcutaneously in the thigh, with 3 having temporary function. In 1954 at Brigham Hospital in Boston, Dr. Joseph Murray performed the first successful human kidney transplant. A patient with chronic renal failure received a kidney from his identical twin brother. Technically, the transplant was a success, and since the donor was an identical twin, no rejection was seen even though the patient did not receive immunosuppressant. This remarkable event proved several things. First, organ replacement could cure a patient; second, organ transplantation was technically feasible; and third, organ transplantation offered a permanent cure of the disease itself. Dr. Joseph Murray and Dr. E. Donnall Thomas received the Nobel Prize for the development of clinical transplantation in 1990.
The immune system presented a formidable obstacle for successful transplantation. In the late 1950s, experiments with irradiation were done to induce allograft tolerance. However, irradiation had acute toxicities, and most of the patients died from the effects of the exposure. In 1959 and 1960, Dr. Roy Calne, a young British surgeon doing a fellowship with Dr. Murray in Boston, used a new compound supplied to him by Burroughs and Wellcome. The drug was azathioprine, an imidazole derivative of 6-mercaptopurine, which was known to be immunosuppressive in kidney transplantation of the dog. Unlike 6-mercaptopurine, which had to be given intravenously, azathioprine could be given orally. Dr. Calne performed experiments that showed that the drug was indeed extremely powerful in dogs and could prevent rejection. With these findings, the foundation for chemical immunosuppressant was laid. Shortly after Dr. Calne's return to the United Kingdom, he was appointed chairman and chief of surgery at Cambridge University. Dr. Murray rapidly began to exploit this new drug, which was later to be registered under the name Imuran, but he found that the drug had significant clinical toxicities that limited its use. Very few patients tolerated the doses of Imuran that would prevent organ rejection. When rejection occurred, the grafts were always lost.
The situation changed overnight when a young surgeon by the name of Dr. Thomas E. Starzl in Denver presented to the National Institutes of Health a stack of rolled-up wall charts outlining the astonishing results that he had achieved by using a combination of azathioprine and prednisone. By adding prednisone to the azathioprine, he not only lessened the risk of rejection but could treat any rejection that did occur with large doses of the steroid. The rejection would then abate, and the graft was accepted with long-term function.
The 1963 publication of Dr. Starzl's study in Surgery, Gynecology, and Obstetrics skyrocketed the interest in transplantation. Fearless surgeons and physicians along with brave patients began to experiment with organ transplantation and immunosuppressant. New forms of immunosuppressant, such as thoracic duct drainage (Franksson, 1964) and antilymphocyte globulin (Starzl, 1967), became adopted in the community of investigators throughout the world. The work presented by Belzer (1968) and Collins (1969) in organ preservation was another milestone. Organs could now be retrieved at one location and transported to the site of the recipient surgery.
With rudimentary but functioning immunosuppressant, a rapid evolution ensued. Dr. Starzl did the first liver transplants in humans in 1963, followed by Dr. Calne in 1968 and by Dr. Rudolf Pichlmayr in Hanover in 1971. When Dr. Christiaan Barnard performed the first successful heart transplant in humans in 1967 in South Africa, the public became aware of the potential of organ transplantation. The first attempts at pancreas transplantation were done by Dr. C. Walton Lillehei in Minnesota in 1966. In that same year, Dr. Lillehei performed the first small intestinal transplant.
The early 1970s saw continued efforts with immunosuppression and tissue typing/matching. However, in 1978, immunosuppressant was still so poor that the 1-year graft survival rate for cadaveric kidneys in the USA was reported at 47%. That same year, patient mortality was reported at 30%. Maintenance immunosuppressant was too weak to prevent rejection. When rejection occurred, the treatment necessary to turn the rejection around brought with it frightful consequences. In 1978, liver transplantation was only practiced with any regularity in 3 centers—Denver, Colorado; Cambridge, UK; and Hanover, Germany—and had an approximate 75% mortality rate. Heart transplantation, which had been started with a worldwide flurry after Dr. Barnard's highly publicized cases, quickly slowed as the patients succumbed. By the late 1970s, few were attempting to do the operation. Dr. Norman Shumway, who initially developed the technique for heart transplantation and who taught Dr. Barnard, continued in his tireless efforts. He was exceeding a 70% 1-year survival. Pancreas transplantation suffered from poorer results with <10% 1-year graft survival with whole organ grafts worldwide. Transplant surgeons were seen as daredevils working at the fringe of science, often working against the advice of less visionary, but highly outspoken, critics. To be a transplant surgeon was something that very few embraced because of the strenuous effort that was required and the discouraging results.
The revolution in transplantation occurred in May 1978 when for the first time Dr. Calne used a new immunosuppressive fungal metabolite discovered by Sandoz. The drug, cyclosporine, changed the history of organ transplantation. In a few short years, aggressive exploratory studies with this drug allowed the pioneers of transplantation to rapidly move forward. Literally overnight, the graft survival rate for kidney transplantation increased to >70% with a mortality rate of ≤10%. The survival rate of liver transplant recipients quickly reached 80%, and so did the survival rate of heart transplant recipients. Pancreas transplantation, which had suffered from almost universal failure, now suddenly began to see consistent survival rates and improving results. In 1982, Dr. Bruce Reitz presented the first series of successful heart-lung transplants using cyclosporine and prednisone. In 1984, the Food and Drug Administration approved the wonder drug under the trade name Sand immune.
First Organ Transplant
The first human organ transplant was a kidney transplant performed in 1954. The donor of the kidney was the identical twin of the recipient and therefore there was no immune rejection of the organ. The recipient lived for eight years following the transplant and the surgeon who performed the transplant, Dr. Joseph Murray, went on to win the Nobel Prize for this work. The recipient of the first heart transplant, performed in 1967 by Dr. Christiaan Barnard, lived only 18 days. The patient did not die because the new heart failed, but because of pneumonia that the patient acquired due to the patient’s immune system being compromised by the anti-rejection drugs that the patient had to take. These two cases illustrate both the promise and the challenges of organ transplantation: donor organs can greatly extend life, but there is a critical shortage of donors and, unless the donor is the identical twin of the recipient, the recipient’s body will always reject the donor organ. In order to combat this rejection, the patient must take lifelong anti-rejection drugs which compromise the immune system and greatly increase the risk of the patient dying from infections.
In the 1960s, anti-rejection drugs were very poor and hence very few organ transplants took place. In the 1970s, better anti-rejection drugs, particularly cyclosporine, were developed and by the late 1970s many heart transplant patients were living up to five years with their donor hearts. In 1983, the FDA approved cyclosporine for use in organ transplantation, and the first lung transplant patient survived more than six years. Although the improved anti-rejection drugs increased the life expectancy for patients receiving organ transplants, they came with harmful side effects that shortened the recipient’s natural life span. In addition to the side effects, the anti-rejection drugs are also very expensive and can cost $20,000 to $30,000 per year and must be taken for as long as the patient lives.
Despite the side effects and costs, organ transplants have become common enough that the shortage of donors is now the key constraint to organ transplants. To increase the number of organ transplants the U.S. government made a huge effort to increase organ donation. This included Congress passing seven separate pieces of legislation, Medicare paying for donor transplants, several Surgeon Generals making personal appeals for more organ donors and the U.S. Department of Health and Human Services making the Emmy award-winning documentary No Greater Love on the benefits of organ donation. Despite all these efforts, waiting lists for organ transplants continued to grow and by 2011 there were over 100,000 Americans waiting for a donor organ.
In the late 1980s, the field of regenerative medicine emerged as scientists began to apply principles of engineering and cell biology to develop techniques that could restore, maintain or improve body function. Regenerative medicine now includes products that use cells to repair damaged organs and to grow organs outside the body for transplant into the patient. Early successes in regenerative medicine included the skin grafting products Apligraf and Dermagraft, which were approved by the FDA in 1998 and 2001, respectively. Apligraf has since been used to treat over 200,000 patients. However, the regeneration of more complex three-dimensional structures like the trachea proved much harder than two-dimensional structures like the skin. Additional progress came with using regenerated tissue grafts to increase urinary bladder capacity and with regenerating blood vessels for grafting between veins and arteries.
In 2008, a milestone was reached when the two fields of organ transplant and regenerative medicine were combined with the world’s first transplant of a regenerated airway. Even though the airway scaffold came from a donor, because the patient’s own bone marrow cells were used to seed the scaffold after the cells from the donor had been removed, the patient did not require anti-rejection drugs. Other than the transplant of organs between genetically identical twins, such as the first kidney described above, we believe this regenerated airway transplant was the world’s first organ transplant that has not required anti-rejection drugs. In 2011, another milestone was reached with the world’s first transplant of a regenerated airway using a synthetic scaffold. In 2013, additional milestones were reached with the first regenerated trachea transplant in the U.S. and the first regenerated trachea transplant using a synthetic scaffold in a child. The patients getting these transplants have also not needed to take anti-rejection drugs, and because the scaffolds were made in a laboratory, the patients did not have to wait for a suitable donor organ to become available. These breakthroughs open the possibility that the waiting lists for organ transplants can be reduced or even eliminated.
Types of transplant
Autograft
Autografts are the transplant of tissue to the same person. Sometimes this is done with surplus tissue, tissue that can regenerate, or tissues more desperately needed elsewhere (examples include skin grafts, vein extraction for CABG, etc.). Sometimes an autograft is done to remove the tissue and then treat it or the person before returning it (examples include stem cell autograft and storing blood in advance of surgery). In a rotationplasty, a distal joint is used to replace a more proximal one; typically a foot or ankle joint is used to replace a knee joint. The person's foot is severed and reversed, the knee removed, and the tibia joined with the femur.
Allograft and all transplantation
An allograft is a transplant of an organ or tissue between two genetically non-identical members of the same species. Most human tissue and organ transplants are allografts. Due to the genetic difference between the organ and the recipient, the recipient's immune system will identify the organ as foreign and attempt to destroy it, causing transplant rejection. The risk of transplant rejection can be estimated by measuring the Panel reactive antibody level.
Isograft
A subset of allografts in which organs or tissues are transplanted from a donor to a genetically identical recipient (such as an identical twin). Isografts are differentiated from other types of transplants because while they are anatomically identical to allograft, they do not trigger an immune response.
Xenograft and xenotransplantation
A transplant of organs or tissue from one species to another. An example is porcine heart valve transplant, which is quite common and successful. Another example is attempted piscine-primate (fish to non-human primate) transplant of islet (i.e. pancreatic or insular tissue) tissue. The latter research study was intended to pave the way for potential human use if successful. However, xenotransplantion is often an extremely dangerous type of transplant because of the increased risk of non-compatibility, rejection, and disease carried in the tissue.
Split transplants
Sometimes a deceased-donor organ, usually a liver, may be divided between two recipients, especially an adult and a child. This is not usually a preferred option because the transplantation of a whole organ is more successful.
Domino transplants
In people with cystic fibrosis, where both lungs need to be replaced, it is a technically easier operation with a higher rate of success to replace both the heart and lungs of the recipient with those of the donor. As the recipient's original heart is usually healthy, it can then be transplanted into a second recipient in need of a heart transplant. Another example of this situation occurs with a special form of liver transplant in which the recipient suffers from familial amyloidotic polyneuropathy, a disease where the liver slowly produces a protein that damages other organs. The recipient's liver can then be transplanted into an older person for whom the effects of the disease will not necessarily contribute significantly to mortality.
This term also refers to a series of living donor transplants in which one donor donates to the highest recipient on the waiting list and the transplant center utilizes that donation to facilitate multiple transplants. These other transplants are otherwise impossible due to blood type or antibody barriers to transplantation. The "Good Samaritan" kidney is transplanted into one of the other recipients, whose donor in turn donates his or her kidney to an unrelated recipient. Depending on the person on the waiting list, this has sometimes been repeated for up to six pairs, with the final donor donating to the person at the top of the list. This method allows all organ recipients to get a transplant even if their living donor is not a match to them. This further benefits people below any of these recipients on waiting lists, as they move closer to the top of the list for a deceased-donor organ. Johns Hopkins Medical Center in Baltimore and Northwestern University's Northwestern Memorial Hospital have received significant attention for pioneering transplants of this kind.
In February 2012, the last link in a record 60-person domino chain of 30 kidney transplants was completed.
ABO-incompatible transplants
Because very young children (generally under 12 months, but often as old as 24 months,) do not have a well-developed immune system, it is possible for them to receive organs from otherwise incompatible donors. This is known as ABO-incompatible (ABOi) transplantation. Graft survival and peoples mortality is approximately the same between ABOi and ABO-compatible (ABOc) recipients. While focus has been on infant heart transplants, the principles generally apply to other forms of solid organ transplantation.
The most important factors are that the recipient not have produced isohemagglutinins, and that they have low levels of T cell-independent antigens. United Network for Organ Sharing (UNOS) regulations allow for ABOi transplantation in children under two years of age if isohemagglutinin titers are 1:4 or below, and if there is no matching ABOc recipient. Studies have shown that the period under which a recipient may undergo ABOi transplantation may be prolonged by exposure to nonself A and B antigens. Furthermore, should the recipient (for example, type B-positive with a type AB-positive graft) require eventual retransplantation, the recipient may receive a new organ of either blood type.
Limited success has been achieved in ABO-incompatible heart transplants in adults, though this requires that the adult recipients have low levels of anti-A or anti-B antibodies. Kidney transplantation is more successful, with similar long-term graft survival rates to ABOc transplants.
Transplantation in obese individuals
Until recently, people labeled as obese were not considered appropriate candidates for renal transplantation. In 2009, the physicians at the Center performed the first robotic kidney transplantation in an obese recipient and have continued to transplant people with Body Mass Index (BMI)’s over 35 using robotic surgery. As of January 2014, over 100 people that would otherwise be turned down because of their weight have successfully been transplanted.

Organ Transplant Timeline * 1954: On December 23, the first successful living-related kidney transplant led by Dr. Joseph Murray and Dr. David Hume at Brigham Hospital in Boston: A kidney was transplanted from Ronald Herrick into his identical twin, Richard. about this history-making transplant. * 1962: First successful kidney transplant from a deceased donor, led by Dr. Joseph Murray and Dr. David Hume at Brigham Hospital in Boston. * 1963: First successful lung transplant led by Dr. James Hardy at the University of Mississippi Medical Center in Jackson, MS. * 1966: First successful pancreas/kidney transplant led by Drs. Richard Lillehei and William Kelly at the University of Minnesota in Minneapolis, MN. * 1967: First successful liver transplant led by Dr. Thomas Starzl at the University of Colorado in Denver, CO. * 1967: First successful heart transplant led by Dr. Christiaan Barnard at Groote Schuur Hospital in Cape Town, South Africa. * 1968: First successful heart transplant in the United States led by Dr. Norman Shumway at Stanford University Hospital, CA. * 1968: Uniform Anatomical Gift Act establishes the Uniform Donor Card as a legal document for anyone 18 years of age or older to legally donate his or her organs upon death. * 1972: End Stage Renal Disease Act (ESRD) paves way for Medicare Coverage of Renal Dialysis and Kidney Transplants * 1981: First Successful heart/lung transplant led by Dr. Brice Reitz at Stanford University Medical Center, Stanford, CA. * 1983: FDA approves Cyclosporine, the most successful anti-rejection medication developed to date; by 1984, two-thirds of all heart transplant patients survived for five years or more. * 1983: First successful single lung transplant led by Dr. Joel Cooper from the Toronto Lung Transplant Group, at Toronto General Hospital in Canada. * 1984: National Organ Transplant Act (NOTA) establishes a nationwide computer registry operated by the United Network for Organ Sharing (UNOS); authorizes financial support for Organ Procurement Organizations (OPOs); prohibits buying or selling of organs in the United States. * 1986: Dr. Michael DeBakey performs the world’s first heart transplant in 14 years. (USA) * 1986: First successful double-lung transplant led by Dr. Joel Cooper from the Toronto Lung Transplant Group, at Toronto General Hospital in Canada. * 1986: Required Request Laws require hospitals to develop policies to identify patients as potential donors and approach families about organ donation. * 1988: FDA approves Viaspan, which greatly extends the preservation of donated livers * 1989: First successful small intestine transplant (a near-total small bowel from a deceased donor) into a child, led by Dr. Olivier Goulet in Paris, France. * 1989: First successful living-related liver transplant led by Dr. Christoph Broelsch from Hamburg, Germany, at the University of Chicago Medical Center. * 1990: First successful living-related lung transplant led by Dr. Vaughn Starnes at Stanford University Medical Center in Palo Alto, California. He transplants the lobe of one lung from an adult female into the woman’s 12-year-old daughter * 1992: First baboon to human liver transplant performed by Drs. Satoru Todo, Andreas Tzakis and John Fung, under the direction of pioneer transplant surgeon Thomas Starzl, at the University of Pittsburgh Medical Center. * 1998: National Conditions of Participation legislation enacted; required hospitals to refer all deaths, and imminent deaths, to the local Organ Procurement Organizations (OPOs) * 1998: First successful hand transplant led by Australian Dr. Earl Owen and Frenchman Dr. Jean-Michel Dubernard in a 13-hour long operation in Lyon, France. * 2005: First successful partial face transplant led by Dr. Bernard Devauchelle and Dr. Jean-Michel Dubernard in Amiens, France. * 2008: Dr. Michael DeBakey, the world-famous cardiovascular surgeon who pioneered such now-common procedures as bypass surgery and invented a host of devices to help heart patients, died on July 11, at the age of 99. * 2010: The world’s first full face transplant took place in Spain. The recipient was a man injured in a shooting accident. In July, the recipient who was only identified as Oscar (age 31), spoke with considerable difficulty at a news conference at Barcelona's Vall d'Hebron hospital, where he was operated on in late March.
Heart Transplanting
Description
Finding a donor heart can be difficult. The heart must be donated by someone who is brain-dead but is still on life support. The donor heart must be matched as closely as possible to your tissue type to reduce the chance that your body will reject it.
You are put into a deep sleep with general anesthesia, and a cut is made through the breastbone. * Your blood flows through a heart-lung bypass machine while the surgeon works on your heart. This machine does the work of your heart while your heart is stopped, and supplies your body with blood and oxygen. * Your diseased heart is removed and the donor heart is stitched in place. The heart-lung machine is then disconnected. Blood flows through the transplanted heart. * Tubes are inserted to drain air, fluid, and blood out of the chest for several days, and to allow the lungs to fully re-expand. * In some cases, the surgeon will not remove the old heart, but will put the new heart on top of it (heterotopic transplant).
Why the Procedure is Performed
A heart transplant may be done to treat: * Severe angina that can no longer be treated with medications or other surgeries * Severe heart failure, when medicines, other treatments, and surgery no longer help * Severe heart defects that were present at birth and cannot be fixed with surgery * Life-threatening abnormal heartbeats or rhythms that do not respond to other treatments
Heart transplant surgery may not be used in patients who: * Are malnourished * Are older than age 55 to 60 * Have had a severe stroke or dementia * Have had cancer * Have HIV infection * Have infections, such as hepatitis, that are active * Have insulin-dependent diabetes and other organs that aren't working correctly * Have kidney, lung, nerve, or liver disease * Have no family support and do not follow their treatment * Have other diseases that affect the blood vessels of the neck and leg * Have pulmonary hypertension (thickening of blood vessels in the lung) * Smoke or abuse alcohol or drugs, or have other lifestyle habits that may damage the new heart
The doctor may not recommend a heart transplant if the patient may not be able to keep up with the many hospital and doctor's office visits, tests, and medications needed to keep the new heart healthy.
Risks
Risks from any anesthesia are: * Reactions to medications * Problems breathing
Risks from any surgery are: * Bleeding * Infection
Risks of transplant include: * Blood clots (deep venous thrombosis) * Damage to the kidneys, liver, or other organs from anti-rejection medications * Development of cancer from the drugs used to prevent rejection * Heart attack or stroke * Heart rhythm problems * High cholesterol levels, diabetes, and bone thinning from the use of rejection medications * Increased risk for infections due to anti-rejection medications * Rejection of the heart * Severe coronary artery disease * Wound infections
Before the Procedure
Once the doctor refers you to a transplant center, you will be evaluated by the transplant team. They will want to make sure that you are a good candidate for a transplant. You will visit many times over several weeks or even months. You will need to have blood drawn and x-rays taken. The following may also be done: * Blood or skin tests to check for infections * Tests of your kidney and liver * Tests to evaluate your heart, such as EKG, echocardiogram, and cardiac catheterization * Tests to look for cancer * Tissue and blood typing, to help make sure your body will not reject the donated heart
You will want to look at one or more transplant centers to see which would be best for you: * Ask them how many transplants they perform every year and what their survival rates are. Compare these numbers with the numbers from other centers. * Ask what support groups they have available and how much help they offer with travel and housing. * Ask about the costs of medications you will need to take afterwards.
If the transplant team believes you are a good candidate, you will be put on a national waiting list for a heart: * Your place on the list is based on several factors. Key factors include the type and severity of your heart disease, and the likelihood that a transplant will be successful. * The amount of time you spend on a waiting list is usually NOT a factor for how soon you get a heart, except in the case of children.
Most, but not all, patients who are waiting for heart transplants are very ill and need to be in the hospital. Many will need some sort of device to help their heart pump enough blood to the body. Most often this is a ventricular assist device (artificial heart-like device).
After the Procedure
You should expect to stay in the hospital for 7 to 21 days after a heart transplant. The first 24 to 48 hours will likely be in the intensive care unit (ICU). During the first few days after a transplant, you will need close follow-up to make sure that you do not get an infection and your heart is working well.
The recovery period is about 6 months. Often, your transplant team will ask you to stay fairly close to the hospital for the first 3 months. You will need to have regular check-ups with blood tests, x-rays, and echocardiograms for many years.
Fighting rejection is an ongoing process. The body's immune system considers the transplanted organ an infection and fights it. For this reason, organ transplant patients must take drugs that suppress the body'simmune response. Taking medicines and following your doctor's instructions carefully is very important to preventing rejection.
Biopsies of the heart muscle are often done every month during the first 6 to 12 months after transplant, and then less often after that. This helps the doctor determine if your body is rejecting the new heart, even before you have symptoms.
You must take drugs that prevent transplant rejection for the rest of your life. You will need to understand how to take these medications, and know their side effects.
You can go back to your normal activities as soon as you feel well enough, and after talking with your doctor. However, avoid vigorous physical activity.
To make sure that you do not develop coronary disease after a transplant, you may have cardiac catheterization every year.
Outlook (Prognosis)
Heart transplant prolongs the life of patients who would otherwise die. About 80% of heart transplant patients are alive 2 years after the operation. At 5 years, 70% of people will still be alive after a heart transplant.
The main problem, as with other transplants, is rejection. If rejection can be controlled, survival increases to over 10 years.
Alternative Names
Cardiac transplant; Transplant - heart; Transplantation - heart