Heart transplant for heart failure

Content provided by Healthwise

Heart transplant for heart failure

A heart transplant is a major surgery in which your failing heart is removed and replaced with a healthy heart from an organ donor. A transplant is the only real "cure" for heart failure. If you have end-stage heart failure, ask your doctor whether a heart transplant might be an option for you.

Who gets transplants? Heart transplants are recommended for people whose life expectancy is less than 1 year and who do not respond to other medical or surgical treatments. Transplants are considered only for people with severe end-stage heart failure, both because of the risks of the transplant surgery itself and because of the shortage of donor organs in the United States.

What are the risks? Very high risks are associated with the surgery itself and with postoperative complications, including:

• High death rates for both the operation and the first year after a transplant.
• Increased chances of catching common infections because of medicines needed to prevent the body from rejecting the new heart (immunosuppressive medicines).

Is there a shortage of hearts? Donated organs are given first to the people who are the sickest. Only a small percentage of people in the United States who need a new heart, lung, kidney, pancreas, or intestine will qualify for a waiting list for a transplant. An extremely small fraction of people with heart failure will receive a heart transplant as part of their treatment.

Will I be chosen? Doctors recommend heart transplants for people with the greatest chance of success with the procedure. Your doctor will consider many factors in assessing your probability of receiving a transplant. These factors include:

• The severity of your heart failure and whether your life expectancy is less than 1 year.
• Whether you have exhausted all other treatment options.
• Your overall health and whether other health conditions might affect the success of a transplant.
• Your lifestyle and whether you can make the lifestyle changes needed for a successful transplant.
• The emotional state of both you and your family. You and your family must cope with a rigorous process during which you will need a high level of support.

What decreases my chances of receiving a transplant? Certain other factors will automatically make you a poor candidate for a heart transplant. Although they do not immediately disqualify you, they do decrease the likelihood that a heart transplant will be successful. Such factors include:

• Older age.
• History of cancer.
• Active infection.
• Diabetes (insulin-dependent) with damage to other organs, such as the kidneys.
• Chronic disease of other major organs.
• Psychiatric illness.
• Substance abuse.
• History of not being able to follow medical treatments.

Several major medical conditions can completely disqualify you from being a transplant candidate. These illnesses already affect your body so severely that a heart transplant probably would not be successful. These conditions also may have already significantly decreased your life span, and a heart transplant probably would not lengthen it. These conditions include:

• Ongoing cancer.
• Cirrhosis of the liver.
• Severe chronic pulmonary disease.

What if I am chosen? If your doctor considers you eligible for a transplant and you have evaluated the risks of the procedure, you may be placed on a waiting list for a donated heart. Your doctor can help you understand the hospital's waiting list. Be aware that each hospital sets its own standards and that you may qualify for a transplant at one hospital and not at another.

Where will I be in line for a transplant? Once you are placed on a hospital's waiting list, you automatically become a candidate on the national waiting list for organs. Your eligibility to receive an organ will be analyzed. You will be assigned a status that corresponds to your state of health. Status 1A is the designation given to the sickest heart transplant candidates. Therefore, all donated organs are offered first to status 1A patients. Only if no 1A patients match the donated organ will it be offered to someone in a relatively better state of health. Therefore, your best chance of receiving a donated heart comes once you have been designated as status 1A. Unfortunately, this is also the time when you will be most ill and susceptible to death.

To be considered status 1A, you must meet one of the following criteria:

• Having a life expectancy of less than 7 days without a heart transplant
• Being treated with an artificial device, such as a ventricular assistive device (VAD) or an artificial heart
• Being on a respirator (a mechanical ventilation device)
• Receiving continuous intravenous infusion of one or more high-dose inotropes (such as dobutamine or milrinone)

If you are considered status 1A and a donor heart becomes available, the transplantable heart will be offered to your hospital for you.

Cost

A heart transplant is an extremely expensive procedure. The hospital stay and surgical procedure cost $100,000 or more. In the long-term, the drugs you must take to prevent your body from rejecting your new heart are very expensive as well. Fortunately for many older Americans, heart transplants are covered by Medicare. Unfortunately, Medicare will only cover 3 years of the long-term drugs after a transplant.

How am I matched to a donor heart? To be offered an available donated heart, you must "match" the donor. "Matching" means that the particular heart is right for you and your body. A variety of factors are taken into account in determining a match. Two of the most important factors are:

• Blood type, because your body will reject a donor heart from a person whose blood type is not compatible with your blood type.
• Overall body size, because you need a heart that is accustomed to pumping about the same amount of blood as you have in your body.

What hearts go where? The United Network for Organ Sharing (UNOS) is the nonprofit organization that maintains organ waiting lists and distributes donated organs. Although the waiting lists for organs are national, donated organs are matched to transplant candidates on a geographical basis. Donor organs first will be matched to a person in a local hospital that is in the same area as the organ's donor. A local area can be a single county, a state, or several states (depending on the size of the population). If no local area transplant candidate matches the donated heart, UNOS will attempt to match a candidate in the donor's region. Finally, if there are no regional transplant candidates who match the donated heart, the heart will be offered to national candidates. It is therefore impossible to estimate the amount of time you will spend waiting for a donor heart. The wait time varies from place to place depending on such factors as the number of organ donors in the population and the number of transplant candidates waiting.

What if I am not chosen? If you find you are not a candidate for heart transplant surgery, other treatments are available to you. For example, palliative care (to control your pain), alternative therapies, and experimental treatments are some of your options.

Credits

Last updated:	September 01, 2006
Author:	Robin Parks, MS
Reviewed By:	Caroline S. Rhoads, MD - Internal Medicine, Stephen Fort, MD, MRCP, FRCPC - Interventional Cardiology
Editors:	Kathleen M. Ariss, MS, Terrina Vail