Heart Transplant: Life-Saving Treatment for End-Stage Heart Failure

What is Heart Transplant?

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Heart transplant (cardiac transplantation) is removing the diseased heart and replacing it with a healthy heart from a brain-dead donor. It is the last resort treatment in end-stage heart failure when other treatments are insufficient.

The first successful heart transplant was performed in 1967 in South Africa by Dr. Christiaan Barnard. Since then, surgical techniques and immunosuppressive therapies have made significant progress.

Types of Heart Transplant:

• Orthotopic heart transplant: The standard method. The patient’s heart is removed and the donor heart is placed in the same position.
• Heterotopic heart transplant: A rarely used method. The donor heart is placed alongside the patient’s own heart.

Who is Eligible for Heart Transplant?

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Definite Indications

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• End-stage heart failure: Patients with very low EF (ejection fraction) despite all treatments
• Refractory cardiogenic shock: Shock not responding to medications and mechanical support
• Treatment-resistant ventricular arrhythmias: Arrhythmias not controlled despite ICD and ablation
• Congenital heart disease: Congenital heart anomalies that cannot be surgically corrected

Evaluation Criteria

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Heart transplant candidates undergo comprehensive evaluation:

• VO2 max <12-14 ml/kg/min: Severe reduction in exercise capacity
• Ejection fraction <20%: Critical reduction in heart pumping power
• Recurrent hospitalizations: Multiple hospitalizations for heart failure in the last year
• Inotropic dependence: Inability to survive without medications

Heart Transplant Contraindications

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Absolute Contraindications (Cannot Be Performed)

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• Active infection (uncontrollable)
• Active cancer
• Irreversible pulmonary hypertension
• Severe peripheral or cerebrovascular disease
• Active substance abuse

Relative Contraindications

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• Advanced age (>70)
• Morbid obesity (BMI >35)
• Complicated diabetes
• Severe kidney or liver disease
• Psychosocial problems or history of non-compliance

Heart Transplant Process

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1. Evaluation Phase

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A comprehensive evaluation process is applied:

• Cardiac tests: Echocardiography, coronary angiography, right heart catheterization
• Pulmonary evaluation: Lung function tests, pulmonary vascular resistance measurement
• Laboratory: Blood type determination, HLA typing, infection screening
• Psychiatric evaluation: Compliance and support system evaluation
• Social services evaluation: Family support, financial situation

2. Waiting List

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Patients who pass the evaluation are placed on the national organ transplant waiting list:

• Urgency status: Ranking by UNOS system (1A, 1B, 2, etc.)
• Blood type compatibility: Required
• Tissue compatibility: HLA matching
• Body size: Donor-recipient match
• Geographic proximity: Organ transport time is critical

3. Surgery

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The surgical process begins when a suitable donor is found:

1. Donor heart procurement: From a brain-dead donor whose family has given consent
2. Heart preservation: Cooled and transported with special preservation solutions
3. Removal of patient’s heart: With cardiopulmonary bypass support
4. Placement of new heart: Connection of aorta, pulmonary artery, and atria
5. Starting the heart: Electrical stimulation and resuscitation

Surgery Duration

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Total duration: 4-8 hours

Life After Heart Transplant

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Immunosuppressive Therapy

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Lifelong medication is required to prevent the body from rejecting the new heart:

• Calcineurin inhibitors: Tacrolimus or cyclosporine
• Antiproliferative agents: Mycophenolate mofetil
• Corticosteroids: Prednisolone (may be reduced over time)

Follow-up Program

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Close follow-up is essential after transplant:

• Endomyocardial biopsy: Frequent in the first year, then annually
• Echocardiography: At regular intervals
• Coronary angiography: Annually (transplant vasculopathy screening)
• Laboratory tests: Drug levels, kidney and liver functions

Possible Complications

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• Acute rejection: Most common in the first year, early detection with biopsy
• Infections: Risk increases due to immunosuppression
• Transplant vasculopathy: Chronic damage to coronary arteries
• Malignancy: Slightly increased cancer risk in the long term
• Kidney failure: Drug-related

Heart Transplant Results

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Quality of Life

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In the majority of patients after successful heart transplant:

• Symptoms significantly improve
• Exercise capacity increases
• Return to normal social life is achieved
• Work life can continue
• Travel is possible

LVAD: Bridge to Heart Transplant

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Left ventricular assist device (LVAD) can be used as “bridge therapy” in patients waiting for heart transplant. It helps the patient survive until a suitable donor is found.

In some patients, LVAD can also be applied as permanent treatment (destination therapy).

Frequently Asked Questions

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Consult a cardiology specialist for heart transplant evaluation or detailed information about advanced heart failure treatment.