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.
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