A heart transplant, or a cardiac transplant, is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease when other medical or surgical treatments have failed. As of 2016, the most common procedure is to take a functioning heart (with or without transplantation of a lung or lungs; a cadaveric donor cardiectomy) from a recently deceased organ donor (the cadaveric allograft), and implant it into the patient.
The patient’s own heart is either removed (the cardiectomy for the recipient) and replaced with the donor heart (orthotopic procedure) or, less commonly, the recipient’s diseased heart is left in place to support the donor heart (heterotopic procedure).
Approximately 3500 heart transplants are performed every year in the world, more than half of which occur in the US. Post-operation survival periods average 15 years. Heart transplantation is not considered to be a cure for heart disease, but a life-saving treatment intended to improve the quality of life for recipients.
Some patients are less suitable for a heart transplant, especially if they suffer from other circulatory conditions related to their heart condition. The following conditions in a patient increase the chances of complications;
- Advanced kidney, lung, or liverdisease
- Active cancer if it is likely to impact the survival of the patient
- Life-threatening diseases unrelated to heart failureincluding acute infection or systemic disease such as systemic lupus erythematosus, sarcoidosis, or amyloidosis
- Vascular diseaseof the neck and leg arteries.
- High pulmonary vascular resistance – over 5 or 6 Wood units.
- Insulin-dependent diabeteswith severe organ dysfunction
- Recent thromboembolismsuch as stroke
- Severe obesity
- Age over 65 years (some variation between centers) – older patients are usually evaluated on an individual basis.
- Active substance abuse, such as alcohol, recreational drugs or tobaccosmoking (which increases the chance of lung disease)
- Patients who are in need of a heart transplant but do not qualify, may be candidates for an artificial heartor a left ventricular assist device (LVAD).