Heart transplant explained
Who needs a heart transplant?
Heart transplant surgery might be considered if you have advanced heart failure and other treatments are not working. Heart failure is when your heart is not pumping as much blood and oxygen around your body as it should.
Your cardiologist will send you for an assessment if they think you may need a heart transplant.
What is a heart transplant assessment?
A heart transplant assessment is to see if a transplant is the best option for you and to check that you’re well enough to cope with surgery and the aftercare.
A heart transplant assessment will include tests, such as:
- tests of your heart, lungs and blood vessels
- blood tests
- antibody tests (a type of blood test to check your immune response).
Based on the transplant assessment, you might be:
- Suitable for a transplant – you’ll be put onto the active transplant waiting list. This means you might be called for a transplant at any time.
- Potentially suitable for a transplant – your current condition means you’re too well to go on the waiting list. If this happens, you’ll be reviewed regularly. If your condition gets worse, you may then go on the waiting list.
- In need of further investigations or treatment – more information is needed before a decision is made.
- Not suitable for a heart transplant – you may not be well enough to cope with the surgery, recovering from another serious illness or cannot take the required medicines after surgery. Your doctor will discuss other treatments with you.
Find out why you may not be suitable for a heart transplant on the NHS website.
Benefits and risk
What are the benefits and risks of a heart transplant?
Most people who have a heart transplant have:
- a longer life
- a better quality of life
- more energy
- Improved wellbeing.
However, it’s a big surgery and there can be complications during and after surgery. Not every person will feel better after a transplant or live longer.
Complications of a heart transplant may include:
- your body rejects the donor heart because it knows it’s a different heart
- your new heart does not work well enough
- infections – however, serious infections are rare
- bleeding
- stroke
- high blood pressure
- diabetes
- problems with your kidneys
- dying during or after surgery.
There may also be complications in the months and years after a heart transplant. These include:
- problems caused by the medicines you need to take after surgery
- narrowing of the arteries that supply the transplanted heart with blood
- higher risk of some types of cancer, including skin cancer.
Your doctor or surgeon will go through your individual risk with you and explain the benefits and risks of surgery to you. Talk to them if you have any worries or questions.
Read more about the risks and benefits of heart transplant surgery.
Preparing for a heart transplant
How long is the wait for a heart transplant?
The average wait time for a donor heart in the UK is 18 to 24 months.
While a suitable heart could be available within days, it can also take months or even years. The time it takes to be offered a heart transplant depends on several factors personal to you.
First, your doctor will assess you and place you on 1 of 3 waiting lists:
- routine if you’re relatively healthy
- urgent if you’re unwell
- super-urgent if you’re very ill.
Although you’ll usually receive a transplant quicker if you’re on a more urgent list, this does not always happen. You can move up a list if you become more unwell.
Whether you’re offered a donor heart can depend on:
- the list you’re on
- how long you’ve been waiting
- where you live
- how much the heart will benefit you
- if your blood type matches a donor heart
- if your height and weight is like the donor
- if your body is more likely to reject the donor heart.
There are more people waiting for a transplant than there are donors and unfortunately some people do not receive their heart transplant. Your heart transplant team will support you while you’re on the waiting list.
How can I prepare for surgery?
Waiting for a transplant can be very hard and stressful. Talk to your transplant team about how to manage these difficult feelings. It can help to carry on doing things you enjoy and to prepare yourself for the surgery.
Find out how to get in shape for surgery with our 5 tips.
Some patients being considered for a heart transplant may need to have a left ventricular assist device (LVAD) until a suitable donor heart becomes available. This device helps pump blood around the body.
What happens when a suitable heart becomes available?
When a donor heart is available, your transplant team will check if it's suitable for you.
If they think it's suitable, you’ll be contacted and asked to go to the transplant centre. There you’ll have some tests to make sure that you're well enough for surgery.
Occasionally there may be a problem, which means unfortunately the transplant cannot go ahead. The team will explain this to you.
During a heart transplant
What happens in a heart transplant operation?
Heart transplant surgery usually takes between 4 and 6 hours. Before surgery, your surgeon will explain what's going to happen.
The steps they’ll usually follow are:
- You’ll be given general anaesthetic, a medicine to put you to sleep.
- The surgeon will make a cut in the middle of your chest (breastbone) to get to your heart.
- You'll be connected to a heart-lung bypass machine to keep blood pumping around your body during surgery.
- Your surgeon will then work on the transplant.
- When this is finished, your new heart begins to take over pumping blood, and the heart-lung machine will be turned off.
- The surgeon will close your breastbone by stitching it with wire, which will stay there for the rest of your life. The skin on your chest will be closed with stitches.
After surgery you'll be moved to the intensive care unit (ITU). Most people wake up the day after, but it can take a little longer as the anaesthetic wears off.
At first, you’ll be on a ventilator machine which helps you breathe until you can do it yourself.
You'll be given medicine through a tube in your neck and arms, and you'll have a tube in your bladder (catheter) to measure how much you pee (urine output).
Recovery
How long will my recovery take after a heart transplant?
Most people get out of bed 1 to 2 days after surgery. At this point you’ll be moved into a high dependency or a “step down” unit before being moved to a ward.
You’ll usually leave hospital and go home 2 to 3 weeks after surgery, but this can take longer. A member of the transplant team will prepare you for going home and talk about your medicines and aftercare.
Many people say their time in hospital is a blur. You may find it helpful to write down or have someone with you to help remember the information your given.
Once you go home, start doing short walks around your house and outside. Make sure you get plenty of rest too. Gradually build up how much activity you do.
Everyone’s recovery is different, but most people's strength and energy will gradually return over the next few weeks. You'll also be able return to activities like working and driving.
Talk to your transplant team about when you can return to your usual activities.
In the first year after your transplant, you'll have to visit the hospital often for a check-up and tests to see how well your heart is working. Because of this you may need to avoid going overseas for the first year after your heart transplant.
What should I avoid after heart transplant surgery?
Your transplant team should tell you what you can and cannot do while you recover. Avoid anything too strenuous, like carrying heavy bags, children and pets, or vacuuming, until your wound has healed.
To support your recovery, you should:
- Wear sunscreen when you go outside and stay in the shade to protect your skin.
- Give up smoking or vaping.
- Keep active and exercise regularly.
- Eat a healthy, balanced diet.
- Lower high cholesterol and blood pressure.
- Maintain a healthy weight.
What are the signs and symptoms of infection after surgery?
Contact your transplant team if you notice any signs of infection, such as:
- a high temperature, 38C or higher
- feeling hot and shivery
- shortness of breath
- being sick (vomiting)
- going to the toilet more than usual (diarrhoea)
- feeling more tired than usual (fatigue)
- severe headache
- feeling unwell or “not right”.
Your risk of an infection is higher after a heart transplant because of the immunosuppressant medicines you’ll need to take. These medicines make it harder for your body to fight infections.
Ways to reduce your risk of an infection:
- Avoid anyone who is unwell with a cold, flu or virus.
- Protect yourself from food poisoning by avoiding eating high risk foods, and be careful preparing, cooking and storing food.
- Keep yourself clean and wash regularly.
- Wash your hands regularly, especially after gardening or touching animals.
- Keep pets healthy, wormed, and vaccinated and avoid changing cat litter.
Will I need to take medicines after a heart transplant?
You'll need to take several medicines after surgery. This includes immunosuppressants that you’ll take for the rest of your life.
Immunosuppressants help to prevent your body from rejecting the donor heart. They can have side effects, like increasing your risk of infection. You’ll also need to avoid certain medicines while taking them.
The risk of rejection reduces over time, so after a while the dose can be reduced.
Speak to your doctor, transplant team or pharmacist about your medicine and side effects.
How long will a heart transplant last?
Around three quarters of adults who have a heart transplant in the UK live for at least 5 years after their heart transplant.
Most people who have a heart transplant have a better quality of life and live longer than they would have done without surgery.
Can I get pregnant and start a family if I’ve had a heart transplant?
If you’re thinking of starting a family after a heart transplant, it’s very important that you talk with your transplant team before you try. This is so they can give you information you on the risks, planning and medicines involved.
Can I get in touch with my donor’s family?
If you want to get in touch with your donor’s family after a heart transplant, speak to your transplant team or NHSBT.
They can explain what is possible and guide you through the process.
Get support
Preparing for and having a heart transplant can be very emotional. You may feel grateful and happy. But it's also common to feel low after surgery.
There are people who can help support you:
- Talk to your transplant team.
- Speak to friends and family.
- Call our cardiac nurses.
- Chat to other people who have had a heart transplant.
- Join Heart Matters for support with healthy lifestyle changes.
Visit our emotional wellbeing hub for information on looking after your wellbeing and places to get support.
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