What To Expect Before a Heart Transplant

The Heart Transplant Waiting List

Patients who are eligible for a heart transplant are placed on a waiting list for a donor heart. This waiting list is part of a national allocation system for donor organs run by the Organ Procurement and Transplantation Network (OPTN).

To make sure that organs are distributed fairly, OPTN has policies on how donor hearts are allocated. These policies are based on the urgency of need, the organs that are available for transplant, and the location of the patient who is receiving the heart (the recipient). Organs are matched for blood type and size of donor and recipient.

The Donor Heart

Guidelines on how a donor heart is selected require that the donor meet the legal requirement for brain death and that the appropriate consent forms are signed. Guidelines suggest that the donor be younger than 65 years of age, have little or no history of heart disease or trauma to the chest, and not be exposed to hepatitis or HIV. It's also recommended that the donor heart not be without blood circulation for more than 4 hours.

Waiting Times

Approximately 3,000 people in the United States are on the waiting list for a heart transplant on any given day. About 2,000 donor hearts are available each year. Wait times vary from days to several months and will depend on a recipient's blood type and condition.

A person may be taken off the list for some time if he or she has a serious medical event such as a stroke, infection, or kidney failure.

Time spent on the waiting list plays a part in who receives a donor heart. For example, if a donor heart becomes available and there are two recipients with equal need, the recipient who has been waiting longer will usually get the heart.

Ongoing Medical Treatment

Patients on the waiting list for a donor heart receive ongoing treatment for heart failure and other medical conditions.

Treating arrhythmias (irregular heartbeats), for example, is very important because they can cause sudden cardiac arrest in people who have heart failure. As a result, many transplant centers will place implantable cardioverter defibrillators (ICDs) in patients before surgery. An ICD is a small device that's placed in the chest or abdomen to help control life-threatening arrhythmias.

Another treatment that may be recommended to waiting list patients is an implanted mechanical pump called a ventricular assist device (VAD), which helps the heart pump blood.

Regular outpatient care for waiting list patients may include frequent exercise testing, assessing the strength of the heartbeat, and right cardiac catheterization (a test to measure blood pressure in the right side of the heart).

Contact With the Transplant Center During the Wait

People on the waiting list are often kept in close contact with the transplant center because most donor hearts must be transplanted within 4 hours after removal from the donor.

At some heart transplant centers, recipients receive a pager so the center can contact them at any time. They're asked to notify the transplant center if they're going out of town. Recipients often need to be prepared to arrive at the hospital within 2 hours of being notified about a donor heart.

Not all patients who are called to come to the hospital will get a heart transplant. Sometimes, at the last minute, the donor heart is found to be unsuitable for certain patients. Other times, patients from the waiting list are called to come in as possible substitutes in case something happens with the selected recipient.