Heart Transplant Patient Guide
The Heart Transplant Program at the Smidt Heart Institute is the largest heart transplant program in the United States. For a person in desperate need of a new heart, the program’s expert and innovative team provides comprehensive, individualized cardiac care before and after the transplant.
Our team consists of cardiologists and cardiothoracic and transplant surgeons who, through their expertise, are contributing to the field of heart transplantation worldwide. In addition, our patients have access to specially trained nurses, 19 transplant coordinators who are available 24/7, dedicated dietitian, social worker, psychiatrist, financial coordinator, pharmacist, and physical and occupational therapists.
For additional general information about our Heart Transplant Program and the services we provide, please see:
As you prepare for, receive and recover from your heart transplant, strong support is available for you and your family. Cedars-Sinai and various organizations in your community can provide educational, financial and emotional assistance.
A support group for all Cedars-Sinai organ transplant patients meets every Tuesday, 1-2:30 p.m., on the sixth floor of the North Tower in room 6159. For more information about this meeting, please contact Carlie Galloway, licensed clinical social worker, at 310-423-6850; or email at email@example.com.
We also have a heart transplant ambassador program, which offers peer-to-peer connections for our heart transplant patients. This program offers an opportunity for heart transplant recipients to share their experiences and offer encouragement to heart transplant patients and their families, new or on the waiting list. To connect with a heart transplant ambassador, contact the cardiac patient liaison at 310-467-4938.
Unfortunately, there is no way to predict how long a given patient will remain on the waiting list for a donor heart. The wait time is dependent on several factors, including the urgency for transplantation, the size of the heart and blood type. The time may vary from several days — when a heart is needed urgently — to months or, in some cases, years.
Each transplant center is located within a designated region, and its potential recipients are put on that region's list. Organs are offered first to the sickest patients who match blood type and size. If a match is not found within the region, organs may be offered to patients outside the region.
Status 1A is the top priority status. Patients with this designation are critically ill, either staying in intensive care units or receiving advanced life-support therapies. Any available donor hearts are offered first to Status 1A patients.
Status 1B is the next highest priority. These patients require special intravenous medications called inotropes (for example, dobutamine or milrinone) to help their heart function adequately while they are waiting for a donor heart. Under the rules of the United Network for Organ Sharing, patients listed as Status 1B may wait either in the hospital or at home, depending on their medical condition.
Status 2 patients do not require intravenous medications while waiting for transplantation and, for the most part, are not hospitalized while they wait. Donor hearts are offered to Status 2 patients when no Status 1A or Status 1B patients are suitable recipients.
Members of the transplant team evaluate candidates regularly and adjust medical treatment as necessary. Sometimes patients need hospitalization and intravenous drugs to support them during the waiting period. Occasionally, mechanical circulatory support devices are necessary.
After the surgery, you typically will spend one to two days in the recovery room, two to three days in the intensive care unit, and about seven days in the transplant unit. During this time, you will be constantly monitored to ensure that your new heart is functioning well and that there are no complications from the surgical procedure. You also will begin taking special medications to help prevent your body from rejecting your new heart. Before you are discharged, you and your family will receive education and instructions about how to manage your medications, take care of your incision site and schedule follow-up visits in our outpatient clinic.
Heart transplant recipients must take many different medications, each prescribed for a specific therapeutic reason. They fall into four categories:
- Immunosuppressants: Drugs and agents that shut down your body's natural immune responses that would damage your new heart.
- Antibiotics, antivirals and fungicides: Drugs that fend off infection while your natural immune responses are disabled.
- Vitamins, minerals and nutritional supplements: Compounds to aid your body in its efforts to heal and maintain proper functioning.
- Coronary-disease-prevention and antihypertensive medications: Drugs to prevent coronary artery disease and regulate blood pressure.
Most medications will be required immediately after transplant surgery. Over the first year, adjustments will be made by your transplant team, which may include lowering the dosages on some medications and possibly discontinuing others.
After your hospital discharge, you will be closely monitored on an outpatient basis by the post-transplant team. This will include regular tests on your new heart, including blood work, echocardiograms, heart biopsies and clinic visits with a transplant cardiologist. The transplant team will communicate with your cardiologist or primary care physician to provide seamless, coordinated care.
The appropriate time for you to return to work will depend on at least two factors: how you are feeling after surgery, and what type of work you will be doing. As soon as your incision is healed and you are feeling well, you can discuss with your transplant cardiologist when to return to work. Some patients are able to return to work relatively quickly. We encourage patients to resume working as soon as they feel ready and the transplant cardiologist considers the decision medically safe. Generally, most recipients can return to work within six months following surgery.
Some patients may experience rejection after heart transplantation. Because rejection typically occurs without symptoms, it is often diagnosed during a scheduled biopsy, which is why it will be important to comply with your schedule of follow-up visits after your transplant surgery. If rejection is detected, it may require adjustment of medications or other therapies. When detected early, most rejection episodes can be resolved successfully.