Heart Transplantation

Heart transplantation is a type of open-heart surgery (large incisions of 8-10 inches long / involves dividing the breast bone / general anesthesia) performed to remove a person’s diseased or failing heart and replace it with a healthy heart from a deceased donor. Most heart transplants are done on patients who have end-stage heart failure. Heart failure is a condition in which the heart cannot keep up with its workload to pump enough blood to meet the body’s needs. “End-stage” means the condition is so severe that most medical treatments have failed.

Although a great solution for many, a heart transplant isn’t the right treatment for everyone. There are many factors that may disqualify someone, including: advanced age; a separate medical condition that could shorten your life; active infection(s), recent personal medical history of cancer; and the unwillingness to make lifestyle changes necessary to keep your donor heart healthy (e.g. not drinking or smoking).

For those who do not qualify for a heart transplant, a ventricular assist device (VAD) provides an alternative. They are commonly used to provide a temporary solution for patients waiting a heart transplant (bridge to transplant), when heart failure is temporary due to an infection or another acute condition (bridge to recovery), when individuals are not qualified for a heart transplant (long-term therapy).

How to prepare for the procedure

Preparations for a heart transplant often begin long before the surgery. You may begin preparing for a heart transplant weeks, months or years before you receive a donor heart, depending upon the waiting time for transplant.

Taking the first steps

Waiting for a donor organ: If the transplant team determines you're a candidate, then the transplant center will register you on a waiting list. While on this list:

  • Your medical team will closely monitor your condition.
  • Your doctors may recommend a cardiac rehabilitation program.
  • Your doctors may also suggest having a VAD implanted to support your heart while you wait for a donor organ.

What to expect before the procedure

A heart transplant usually needs to occur within four hours of organ removal for the donor organ to remain viable. As a result, hearts are offered first to a transplant center close by, then to centers within certain distances of the donor hospital.

  • When you're notified that a potential organ is available, you and your transplant team have a limited amount of time to consider whether to accept the donation. You'll be expected to travel to the transplant hospital immediately.
  • Once you arrive at the hospital, your doctors and transplant team will conduct a final evaluation to determine if the donor heart is suitable for you and if you're ready to have surgery. If it is decided that you are not, you may not be able to have the transplant.

What to expect during the procedure

Heart transplantation usually takes 4 to 6 hours, but the preparation and recovery may add several hours. The procedure is performed in the cardiothoracic operating room (OR). Check with your doctor about the details of your procedure. In general:

  • You will change into a hospital gown.
  • Prior to starting the procedure, you will receive a local anesthetic. Once you are sedated, your doctor may insert a breathing tube through your throat into your lungs and connect you to a ventilator. This will breathe for you during surgery.
  • Your doctor will administer general anesthesia (will make you feel sleepy).
  • The procedure begins when your doctor cuts the breastbone (sternum) in half and spreads both halves to gain access to your heart (open-heart surgery).
  • For this type of surgery, your heart must be still. Prior to doing so, your doctor will place tubes into your heart so that blood can be pumped through your body by use of a heart-lung machine. This machine takes over for the heart by replacing the heart’s pumping action and the lungs by adding oxygen to the blood.
  • Once the blood has been diverted into the bypass machine for pumping, your doctor will then stop the heart by injecting it with a cold solution.
  • When the heart has been stopped, your doctor will remove the diseased heart and replaced it with the donor’s heart. Once your new heart is in place, he or she will connect the blood vessels carefully so there are no leaks. Once checked, the doctor will let the blood circulating through the bypass machine back into your heart.
  • If your heart is not restarting after the procedure is complete, a mild electric shock may be used to restart it.
  • Your doctor may also put temporary wires for pacing into your heart. These wires can be attached to a pacemaker, if needed, during the initial recovery period.
  • Once the procedure is complete, the machine will be turned off. The tubes will be removed and the sternum will be sewn together with the use or sutures or surgical staples.

Heart Transplant

Medical Illustration Copyright © 2019 Nucleus Medical Media, All rights reserved.

What to expect after the procedure

After the surgery, you will be taken to the cardiothoracic intensive care unit (CTICU) for further observation for several days. Heart transplantation typically requires a hospital stay of 7 to 14 days, or even longer. Other recommendations include:

General guidelines

  • The breathing tube is removed when you wake up from anesthesia.
  • Diet is started the day after surgery with liquids, and quickly advanced to solids as tolerated
  • Ambulation is started on the first or second day of surgery
  • Urine catheters and drainage tubes (chest tubes) are removed after 24 to 48 hours
  • If you have pacing wires, your doctor will remove those too
  • Blood samples will be taken often to monitor your new heart, as well as other body functions
  • Your healthcare team will closely watch your anti-rejection (immunosuppression) medicines to make sure you are getting the right dose and the best combination of medicines.
  • Nurses, respiratory therapists, and physical therapists will work with you as you begin physical therapy and breathing exercises.
  • Your doctor will give you instructions to follow during your recovery
  • A cardiac rehabilitation program may also be suggested


Newark Beth Israel Medical Center
201 Lyons Avenue at Osborne Terrace
Newark, NJ 07112
(973) 926-7000
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Robert Wood Johnson University Hospital
1 Robert Wood Johnson Place
New Brunswick, NJ 08901
(732) 828-3000
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Heart Transplantation Treatment & Care

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