Medical Services > Transplants

To determine whether transplant surgery is appropriate for an individual, a complete health evaluation is necessary. Typically, a patient undergoes three or four days of testing on an outpatient basis for evaluation. Depending on the severity of the patient’s illness this evaluation may take place as an inpatient.

If the transplant physician finds that transplantation is an appropriate option, and the patient wants to receive a heart transplant, he or she will be placed on the transplant waiting list. The patient's name, blood type, body size and status criteria will be placed in the national United Network for Organ Sharing (UNOS) computer. The patient will need to carry a cell phone or beeper to be contacted quickly when a donor becomes available. The patient will receive written notification when activated on the heart transplant waiting list.

The patient's status awaiting a heart transplant is determined by how ill the patient is:

• A status of 2 indicates that the patient is stable and able to wait at home.
• Status 1B describes patients who are more ill and who might be dependent on IV medication to assist the heart (isotropes). Sometimes, Status 1B patients can wait in the community instead of the hospital.
• Status 1A patients are dependent on a mechanical device, such as a balloon pump or a left ventricular assist device (LVAD). These patients also are on two IV medications, in addition to hemodynamic monitoring in the intensive care unit (ICU). Status 1A 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, a patient must live within two hours of the hospital so that he or she can arrive soon after a donor becomes available. The patient should also notify the transplant office about any serious infections he or she may get, such as pneumonia, abscesses or major infections, or should the patient be admitted to another hospital.

The amount of time a patient waits for surgery varies. Time depends on donor availability, the patient's blood type, body size and how sick the patient is. Because of the shortage of donor organs, the waiting time for a transplant is commonly several months.

Procedure

When an appropriate donor heart is ready, the patient will be called. The patient should not eat or drink anything after getting called, and must arrive at the hospital within two hours. The patient is admitted to UT Southwestern 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 will be in surgery within a few hours.

During surgery, the patient's family will be directed to a waiting room and an operating room nurse will update them during the surgery. The surgeon will meet with the family after the surgery is completed.

Heart transplant surgery usually takes four to six hours. The patient's heart will not be removed until the new heart arrives in the operating room.

Recovery

Once surgery is finished, the patient will spend an average of three to four days in the Cardiovascular Intensive Care Unit (CVICU). For the patient's protection while in the CVICU, all visitors and health-care personnel will wear gowns, gloves and masks when in the patient’s room.

Generally, once the patient is breathing safely on his or her own, and the new heart is functioning well, the patient will be transferred out of the CVICU, but will probably spend another five to seven days in the hospital. During this time, the patient will be instructed on medications, future outpatient visits and general health-care issues. As the patient undergoes physical therapy, he or she learns how to take care of the 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. At first, the patient will need to come to the transplant office twice a week. This makes it necessary for the patient to remain in the Dallas area for at least six to 12 weeks, depending on how far his or her home is from the metroplex.

A heart transplant requires a long-term commitment, as patients will need to take medications for the rest of their lives, exercise regularly, eat a healthy diet, abstain from smoking, street drugs and alcohol, and have frequent medical checkups. The UT Southwestern transplant team can assist the patient in taking care of his or her new heart.