The heart-transplant waiting list
Patients who are eligible for a heart transplant are placed on a waiting list for a donor heart.
To make sure that organs are distributed fairly, there are policies on how donor hearts are allocated. These policies are based on the urgency of need, the organs that are available for transplant, and the location of the patient who is receiving the heart (the recipient). Organs are matched for blood type and size of donor and recipient.
The donor heart
Guidelines on how a donor heart is selected require that the donor meet the legal requirement for brain death and that the appropriate consent forms are signed. Guidelines suggest that the donor be younger than 65 years of age, have little or no history of heart disease or trauma to the chest, and not be exposed to hepatitis or HIV. It's also recommended that the donor heart not be without blood circulation for more than 4 hours.
Wait times vary from days to several months and will depend on a recipient's blood type and condition.
A person may be taken off the list for some time if he or she has a serious medical event such as a stroke, infection or kidney failure.
Time spent on the waiting list plays a part in who receives a donor heart. For example, if a donor heart becomes available and there are two recipients with equal need, the recipient who has been waiting longer will usually get the heart.
Ongoing medical treatment
Patients on the waiting list for a donor heart receive ongoing treatment for heart failure and other medical conditions.
Treating arrhythmias (irregular heartbeats), for example, is very important because they can cause sudden cardiac arrest in people who have heart failure. As a result, many transplant centres will place implantable cardioverter defibrillators (ICDs) in patients before surgery. An ICD is a small device that's placed in the chest or abdomen to help control life-threatening arrhythmias.
Another treatment that may be recommended to waiting list patients is an implanted mechanical pump called a ventricular assist device (VAD), which helps the heart pump blood.
Regular outpatient care for waiting-list patients may include frequent exercise testing, assessing the strength of the heartbeat, and right cardiac catheterisation (a test to measure blood pressure in the right side of the heart).
Contact with the transplant centre during the wait
People on the waiting list are often kept in close contact with the transplant centre because most donor hearts must be transplanted within 4 hours after removal from the donor.
Recipients are asked to notify the transplant centre if they're going out of town. They often need to be prepared to arrive at the hospital within 2 hours of being notified about a donor heart.
Not all patients who are called to come to the hospital will get a heart transplant. Sometimes, at the last minute, the donor heart is found to be unsuitable for certain patients. Other times, patients from the waiting list are called to come in as possible substitutes in case something happens with the selected recipient.
What to expect during a heart transplant
Just before the heart-transplant surgery, patients will receive general anaesthesia (that is, they're temporarily put to sleep).
A bypass machine is hooked up to the arteries and veins of the heart. The machine pumps blood through the patient's lungs and body while the diseased heart is removed and the donor heart is sewn into place.
Heart-transplant surgery usually takes about 4 hours. Patients often spend the first days after surgery in the intensive-care unit of the hospital.
Source: US National Institutes of Health: Heart, Lung and Blood Institute