How is the donor heart preserved during transport?
The heart is placed in preservation solution in a sterile bag, which is surrounded with ice cubes.
Why does a donor heart appear yellow and not red?
The layer of fat that covers and protects the heart is yellow.
How long can a heart be stored?
Only four to six hours.
How is the "new" heart started after transplantation?
Once sewn in and perfused with blood, most hearts resume a regular beat and contraction on their own, although the new heart usually requires support with medication for a while.
What is the life expectancy of a heart transplant recipient?
Approximately half of heart transplant recipients are alive at 10 years post transplant.
What would disqualify someone from being a heart donor?
The absence of the following conditions are the suggested criteria for cardiac donors:
- prolonged cardiac arrest
- prolonged severe hypotension
- preexisting cardiac disease
- intracardiac drug injection
- severe chest trauma with evidence of cardiac injury
- extracerebral malignancy
- positive serologies for HIV, hepatitis B or hepatitis C
How old must you be to donate a heart?
You must be younger than 55 years old although there are exceptions.
Does blood type factor into the donor/recipient process?
Yes. ABO blood type has to be compatible
Will we ever be able to grow or print new hearts from stem cells or cultured tissue?
Researchers have been trying this with some promising findings. Although growth of complete new hearts is still on the horizon, current studies are using stem cells to regenerate myocardial cells and help damaged hearts with or without the additional aid of implantable LVAD.
When was the first heart transplant performed and where?
South African Christiaan Barnard surprised the world when he performed the first human-to-human heart transplant on December 3, 1967.
How common is a heart transplant? How many are performed on a yearly basis?
Approximately 3,700 to 3,800 heart transplants are performed worldwide. In the U.S., approximately 2,200 are performed every year.
How many hospitals in the U.S. transplant hearts? In the world at large?
Over 140 centers perform heart transplantation in the U.S. Over 250 centers report to the International Society for Heart and Lung Transplantation as heart transplant center worldwide.
Since organ donation is limited or restricted in Japan, how many patients travel to other countries for a heart transplant? Is the organ donation/transplant process in Japan changing?
Because of extremely limited number of donors in Japan, every year several patients with end stage heart failure, especially pediatric patients, travel to other countries such as the U.S. and Germany. In the U.S., the number of donor hearts that can be allocated to foreign recipients is restricted to fewer than five.
What are the signs and symptoms of organ rejection?
If you feel ill and are experiencing signs or symptoms of rejection at any time after discharge from the hospital, you should immediately contact the Transplant Office at 212.305.7600.
- Fever above 100 degrees F
- Weight gain of over 2 lbs. for 2 days in a row, or a total of 5 lbs. in a week
- Nausea and vomiting
- Shortness of breath
- Dizziness or feeling light headed
- Chest pain
- Either high blood pressure (Systolic over 160 or Diastolic over 110) or low blood pressure
- Painful or burning urination
- Sores or a wound that does not heal
- Flu-like symptoms: fever, chills, sore throat, earache
- Cough, with or without sputum
- Feeling fatigued, tired
- A general feeling "under the weather," not "up to par"
- High blood sugar levels: glucose over 250
What do I do if I feel unwell after surgery?
After transplantation, it is important to take care of yourself by eating right, exercising daily, taking your medications, as prescribed and on time, taking care of your skin and dental hygiene, washing your hands frequently, and using the infection-avoidance precautions we teach. Report any changes or feelings of discomfort to your transplant doctor or transplant coordinator immediately. The timely diagnosis of infection or rejection is crucial to your life. Remember, call us even if in doubt; it is better to be safe than sorry.
How do I reach the Transplant Office if I am having a medical emergency?
During the day someone in the office will pick up your call. If you want to contact the Transplant Office with a routine, non-emergency question we ask that you place these calls during the hospital's normal business hours which are Monday through Friday from 9:00 am to 5:00 pm.
Emergency calls can, and should, be made at anytime. You should alert the person who answers your call that it is an emergency. If your call is made after normal business hours, in the evening and on weekends, our answering service will pick up the call. Let the phone ring until you get an answer; sometimes there can be a longer wait than during business hours.
The receptionist will take your name and number and have the appropriate clinician return your call. You can expect this return call within 20 minutes. If you haven't been contacted by then, call back and leave another message. Be sure to express the urgency of your call.
What dietary changes are necessary after receiving a transplant?
It is likely that, following transplantation, you will be making some important dietary changes. The following section outlines many of these recommended dietary restrictions and why they are important to understand and maintain.
Sodium Restriction and Fluid Retention
You need to restrict the amount of sodium in your diet because it causes your body to retain fluids. In addition, some medications you could be taking, particularly prednisone and ImuranÂ, can exacerbate the situation by causing your body to hold both sodium and fluids. This is why it is doubly important for you to control your intake of both sodium and total fluids. Remember, excess fluid can place great strain on your new heart. Please note that you should also discuss the use of salt substitutes with your doctor. They may be unadvisable for you.
Caloric Restriction and Weight Gain
Your total calorie intake may be changed to decrease or increase your weight. Being overweight increases your heart's workload. Prednisone increases your appetite. You become inclined to eat more and gain weight. It is vital that you pay attention to the total amount of food (caloric intake) you eat. In addition to adding strain to your heart, being overweight is associated with higher levels of fats, or triglycerides, and cholesterol in the blood. Elevated fat levels in your blood increases your risk of developing coronary artery disease and atherosclerosis. Remember that excess calories, regardless of whether they come from fat, protein or carbohydrate sources, will eventually be stored as fat by your body.
Concentrated Carbohydrate Restriction
Calories are present in all the foods we eat--fats, protein and carbohydrates. You may also be asked to reduce the amount of sugar and concentrated sweets in your diet. In large amounts they can contribute to an increase in triglycerides. Steroids, like prednisone, tend to raise blood sugar levels. If your blood sugar does rise above normal levels, it may be necessary to restrict your intake of sweets. If you are diabetic, steroid therapy may also change your insulin requirements. Please note that "reduced fat" and "fat free" products often have high levels of concentrated carbohydrates, so they will still be high in calories.
Cholesterol and Saturated Fat Restriction
Cholesterol is an essential fatty substance that occurs naturally in our bodies and many animal-based foods. In addition to getting cholesterol from your diet, your body makes its own cholesterol in varied amounts. Plant-based foods do not contain cholesterol, however they can still be a significant source of fats, even saturated fats, as with tropical oils. People with large amounts of cholesterol and saturated fats in their blood are at increased risk for narrowing and blocked blood vessels. This is coronary artery disease.
In addition to poor dietary choices, your immunosuppressant medications can raise the level of fats in your blood. To prevent, or slow, the progression of coronary artery disease after surgery you must restrict your overall fat intake.
- Your overall calories from fat should be limited to 30% or less of your total intake each day.
- Your saturated fat intake should not exceed 10% of your total daily fat consumption. Another benefit in protecting your overall cardiac health may come from incorporating good sources of omega-3 fatty acids in your diet. Excellent sources are salmon, catfish, tuna and swordfish.
Foods high in soluble fiber, such as oats, beans and oat bran, help to lower the cholesterol level in your blood. Insoluble fiber, the type which passes through your system unabsorbed, commonly referred to as "fiber" or "roughage," helps prevent constipation, promotes a feeling of satiety (fullness), and may decrease your risk of colon cancer. Good sources of insoluble fiber are raw fruits and vegetables. Your dietitian will suggest ways to increase the amount of fiber in your diet.
Following surgery, you may be given a diet rich in "high biologic value" protein sources such as meat, poultry and fish. This is done to promote the healing of your surgical wounds and improve your overall nutrition. The amount of protein you receive may be altered depending on how well your kidneys are functioning immediately after transplant surgery. Once you have recovered from surgery, a more moderate protein intake will be recommended.
Low Potassium Diet
Potassium (K) is a mineral which is normally present in the bloodstream, but can become elevated when you are taking cyclosporine. Potassium affects the way muscles work, including your heart muscle. Very high potassium levels can cause your heart to beat unevenly and possibly stop altogether. Your doctor and nurse coordinator will advise if you should be adhering to a low potassium diet.
How soon after my transplant operation can I drive?
Because it commonly takes eight weeks for the bones and tissues of your chest to heal after transplant surgery, you must not attempt any resistance exercises or other stress-inducing activities with your arms and upper body. You should not do any heavy lifting, pulling or pushing with your arms. You may not drive! Until you are sufficiently healed to resume driving, generally three months after your operation, a friend or relative will have to provide transportation to and from your clinic appointments.
How soon can I return to work?
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. Whenever deemed medically safe by your transplant cardiologist, we encourage patients to resume working as soon as they feel ready. After transplantation, we expect recipients to participate fully in all of life's activities. This means enjoying family activities, returning to work, leading a normal social life and contributing back to society. Generally, most recipients can return to work within six months following surgery.
What is UNOS?
The transplant community is joined under a nationwide umbrella—the United Network for Organ Sharing, or UNOS. The purpose of UNOS is to promote and advance the science of transplantation, and to increase the availability of donor organs. In September 1986, UNOS was established by contract from the Health Resources and Services Administration, a division of the U. S. Department of Health and Human Services. UNOS manages the national transplant waiting list, matching donor organs to recipients 24 hours a day, 365 day a year. It monitors every organ allocation to ensure compliance with equitable policies that maximize the limited supply of organs and give all patients a fair chance at receiving the organ they need, regardless of gender, race, religion, lifestyle, and financial or social status.
What is the difference between Status I and Status II patients?
Status 1A is the top priority status. These patients are critically ill, either staying in intensive care units and/or receiving advanced life support therapies. Any available donor hearts would first be offered to status 1A patients on the UNOS list.
Status 1B is the next highest priority status after 1A. These patients require special intravenous medications to help their heart function adequately while they are waiting for a donor heart. These medications are called inotropes (e.g. dobutamine, milrinone). Under current UNOS rules, 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 would be offered to Status 2 patients when there are no Status 1A or Status 1B patients who would be suitable recipients.
What is CMV?
Cytomegaly virus or CMV is a form of the herpes virus. It is the single most common type of infection which is seen after heart transplant. Peak incidence is from 2-5 months post transplant. All heart transplant patients are treated prophylactically for CMV infection beginning immediately after transplant. Which drug you are given will be determined by serology (blood test) results from both you and the donor. CMV infection can occur in many different forms—in the blood, gastrointestinal system, or lungs for example.
How can I protect myself from picking up infections?
Here's a list of infection avoidance techniques to follow:
- Wear a surgical mask when you visit the transplant clinic or any hospital.
- Avoid close contact with children who have received live-virus vaccines for four weeks following the vaccination.
- While gardening, wear a mask and gloves to avoid contact with fungus spores which can promote infection.
- Avoid constructions sites whenever possible. If you live near an active construction site, keep your windows closed.
- Avoid cat litter boxes altogether. They too contain fungus spores. Do not change the litter box!
- When you prepare fresh fruits and vegetables, thoroughly clean them while wearing gloves to remove fungus spores.
- Wash your hands frequently, and keep them away from face and mouth.
- Avoid people with colds, flu and other infections. Ask friends to visit only when they are well.
- If you are changing the dressing on a wound, wash your hands carefully before and after.
- Wash your hands immediately after coughing or sneezing. Throw your used tissues in the trash immediately.
- When someone in your family becomes ill be sure not to use the same unwashed plates, utensils and glasses they have.
- Avoid working in the soil for the first six months after your transplant.
- Wear protective gloves and surgical mask thereafter.
- Avoid handling animal waste and avoid contact with stray animals. Do not clean bird cages, or fish or turtle tanks, or cat litter. The litter box should be covered and removed from the house for cleaning by a family member or neighbor.
- Avoid live-virus vaccines such as Sabin oral polio, measles, mumps, rubella, yellow fever, or smallpox. The live virus can cause infection. If you or a family member intends to receive any vaccinations, notify your transplant team or local physician.
May I drink alcohol?
Alcohol consumption should be eliminated or severely restricted after your transplant. Alcoholic beverages are high in calories, low in nutrients and can increase the level of triglycerides in your blood. Even more important is the fact that alcohol can impair your liver's function. Cyclosporine and other medications are broken down in the liver. So, for your medications to work properly and safeguard your new heart from rejection, it is essential that your liver be healthy and properly functioning.
What happens if I forget to take my medications?
Our general guidelines for managing all the medications needed after transplant are:
- DO take all of your medicines as directed by your physician. Never stop taking your medications or change dosages without your physician's approval.
- DO carefully follow the scheduled dosage times.
- DO learn both the generic and brand names of each medication you take, and understand why you are taking it.
- DO keep your medications in their original containers with labeling that displays name, dosage and expiration date.
- DO store medications in a cool, dry place away from direct sunlight.
- DO report all side effects to your transplant cardiologist or coordinator.
- DO keep medications out of reach of small children.
- DO NOT change or skip a medicine unless directed to do so by a member of your transplant team.
- If you miss a dose, DO NOT double the next dose. Contact your transplant cardiologist immediately for instructions.
- DO NOT take any other medications, prescribed or purchased over-the-counter, unless preapproved by your transplant cardiologist or coordinator.
- DO NOT store medications in the refrigerator unless advised to do so by your transplant cardiologist or coordinator.
- DO NOT allow liquid medications to freeze.
- DO NOT drink alcohol. It will compromise the effectiveness of the essential medications you are taking.
What happens when I come back to the clinic?
When you arrive at the Hospital at your appointed time, check in with your nurse coordinator who will be waiting for you at the Clinic. Your follow-up clinic visit usually consists of a physical examination by your cardiologist and nurse coordinator. You will have a chest X-ray, electrocardiogram or EKG, and blood tests. You may also have an endomyocardial biopsy, described below. You'll be moving around our facilities during your visit. Chest x-rays and EKGs are performed at Herbert Irving Pavilion where many of our physicians have their clinical offices. It is across Fort Washington Avenue from The Presbyterian Hospital and is connected to the Milstein Hospital building. Blood work, cyclosporine level testing and biopsies are done at the Transplant Clinic on PH 14.
The timing of your cyclosporine level testing must be carefully controlled. Your blood must be drawn when the amount of medicine is the lowest and we track this by time expired from your last dose. Your blood must be drawn when the amount of medicine in your system is the lowest. If you take cyclosporine on an 8-hour cycle, your blood will need to be drawn 7-1/2 hours after your last dose. Or, if you take cyclosporine every 12 hours, then your blood should be taken 11-1/2 hours following your last dose.
How is the biopsy done and when will I get my results?
The cardiac, or endomyocardial, biopsy is a diagnostic test to detect rejection done frequently on an outpatient basis after heart transplantation. Having an episode of rejection is not uncommon and does not mean that the patient will lose his or her new heart. Rejection will present itself if medications need adjusting and very often the patient may have no symptoms. This is why cardiac biopsies are an important part of routine care after transplantation.
Typical Cardiac Biopsy Schedule (Additional appointments are added as needed):
- First month following transplant: Every visit
- Second month following transplant: Every biweekly visit
- Following four months: Every monthly visit
- Months 6 to 12 after transplant: Every other month
- Months 12 to 18 after transplant: Every 3-month visit
- Months 18-24 after transplant: Every 3 to 6 months
- Annual maintenance schedule: Visit every 6 to 12 months as needed
If you are scheduled for a biopsy it is important that you have not eaten or drunk anything for 6 hours prior to the procedure. You should, however, continue to take all your medications as prescribed with sips of water. During the biopsy, a small piece of heart muscle is removed for microscopic examination to detect rejection. The biopsy is performed through a vein located either in the right side of your neck or in your groin, using a bioptome, a long, thin tube with a tiny cutting edge. The entire procedure takes about 1/2 hour and will be performed either in the Transplant Clinic or the Cardiac Catheterization Lab.
The biopsy results are available from 24 to 48 hours after the procedure. If your biopsy indicates rejection is present, we will immediately treat you by changing your medication regimen. You may require intravenous or additional oral medications. It may be beneficial to have you admitted to the Hospital. But don't panic. Remember that rejection can recur at any time, and rejection is treatable.
What are all the different medications for?
Heart transplant recipients must take many different medications, each prescribed for a specific therapeutic reason. They fall into 4 categories:
- Immunosuppressants — drugs and agents which shut down your body's natural immune responses that would damage your new heart.
- Antibiotics, Antivirals and Fungicides — drugs that intercede to fend off infection because your natural immune responses are now disabled.
- Vitamins, Minerals and Nutritional Supplements — compounds to aid your body in its efforts to heal and maintain proper functioning.
- Coronary-Disease Preventing and Antihypertensive Medications — drugs to prevent coronary artery disease and regulate blood pressure.
The most medications are required immediately after the operation. Over the first year, some dosages can be lowered and possibly discontinued.
What can I do to prevent rejection?
The most important ways to prevent rejection are: Always take all of your medications.
Never alter or skip a dose unless instructed to do so by a member of your transplant team.
May I still see a dentist after transplantation?
Your mouth is a potential source of infection because so many bacteria and fungi are normally present there. This is why we insist that you have a dental evaluation before your surgery. After transplant, it is important that you have regular checkups and maintain good dental hygiene. The routine dental care provided by your regular dentist will help to prevent infections and decrease the amount of gum overgrowth caused by cyclosporine.
When you plan to have dental work, even a check-up or cleaning, you must notify your dentist in advance that you have had a transplant and will require that antibiotics be given prior to the procedure. The reason for this is that bacteria may get into your bloodstream during the dental procedure; these bacteria can promote infection. This prescription can be obtained from your dentist or transplant cardiologist.