Heart transplant - How to prepare for a heart transplant

If it's thought you could benefit from a heart transplant, you will be invited to your local hospital for an initial assessment.

The assessment is to check whether you are a suitable candidate (see below). 

Further assessment

If you are thought to be suitable, following an initial assessment, you will probably be invited to your nearest transplant centre to have a more in-depth assessment.

In England, there are a number of specialist transplant centres that carry out heart transplants. They are:

• Great Ormond Street Hospital for Children and the Royal Brompton and Harefield Hospital, which are both in London
• University Hospitals Birmingham NHS Foundation Trust
• the Freeman Hospital in Newcastle
• the Northern General Hospital in Sheffield
• the Papworth Hospital in Cambridge
• University Hospital of South Manchester

The purpose of having a more in-depth assessment is to build up a more detailed picture of your current state of health, and to check whether there are any underlying problems that could affect your suitability for a transplant.

You will also have the opportunity to meet the transplant team and to find out more about the procedure.

Before visiting the transplant centre, you may find it useful to write a list of questions you would like to ask the transplant team.

Tests

As part of your assessment, you may have some of the tests described below:

• blood tests and urine tests to check for viral or bacterial infections, and to assess the health of organs, such as your liver
• chest X-rays
• blood pressure tests
• a lung function test, which uses a machine called a pulse oximeter to measure the amount of oxygen in your blood
• computerised tomography (CT) scans and magnetic resonance imaging (MRI) scans, which are used to check the health of certain organs, such as your heart and lungs
• coronary angiography – a special type of X-ray used to study the inside of your heart
• an electrocardiogram (ECG) – which measures the electrical activity of your heart

The whole assessment process usually takes two to four days to complete.

Final decision

The final decision about whether you are suitable for a heart transplant is not made by one person, it is a joint decision made by the transplant team as a whole.

You may be informed about the decision before leaving the transplant centre. However, if your case is not straightforward, it may be several weeks before you are told the decision.

Your transplant team may decide you are:

• suitable for a transplant and ready to be placed on a waiting list (see below)
• suitable for a transplant but your condition does not require a transplant – you will usually be monitored in case your condition gets worse
• unsuitable for a transplant – the reasons will be explained in detail by your transplant team (see below)

In some cases, further tests are necessary to make a final decision, or you may be referred to a different transplant centre for a second opinion.

Waiting for a suitable donor

It may be several months before a donated heart of the right size and blood group becomes available.

Your transplant centre can offer support, guidance and information while you wait for a suitable donor to be found. They will be fully aware that many people find this a frustrating and frightening experience.

In some cases, a planned transplant might not go ahead. This may be because your health deteriorates to such an extent that a transplant is no longer considered a safe or effective treatment.

Unfortunately, some people die before a donated heart becomes available.

When a heart transplant is not suitable

There are more transplants needed than donor hearts available, so the assessment process used to decide who can have a heart transplant is strict.

The operation also places a major strain on the body, which means the risks may outweigh the potential benefits for many people.

Therefore, a person is usually only considered a suitable candidate if they are in relatively good health (aside from the condition for which they require the transplant).

You will usually be considered unsuitable for a heart transplant if you:

• are over the age of 65 – though exceptions can be made
• have an incurable form of cancer
• have another serious health condition unrelated to your heart, such as chronic kidney disease
• have HIV and AIDS – medications needed after donation will lower your immunity, which could be extremely dangerous if you have HIV or AIDS
• are currently misusing alcohol or drugs
• are currently smoking
• have a long-term mental health condition, such as schizophrenia, which means it is unlikely you will regularly take medication or attend necessary appointments during the recovery period

The waiting list

Once you are on the active waiting list, the transplant centre may give you a pager so you can be contacted at short notice.

A suitable heart may be available within a few days, or it could take years. The length of time you wait will depend on your blood group, donor availability, how many other patients are on the list and how urgent their cases are.

Around one in three patients on the transplant list are too ill to go home and need to stay in hospital while they wait for a donor heart. Priority is usually given to these patients.

While you wait, you will be cared for by the doctor who referred you to the transplant centre. Your doctor will keep the transplant team updated with changes to your condition. Another assessment is sometimes necessary, to make sure you are still suitable for transplant.

Getting the call

When a suitable donor heart is found, the transplant centre will contact you and ask you to go to the centre.  

When you hear from the transplant centre:

• do not eat or drink anything
• take all current medicines with you
• take a bag of clothes and essentials for your hospital stay

At the transplant centre, you will be reassessed quickly to make sure no new medical conditions have developed. At the same time, a second medical team will examine the donor heart.

For the transplant to have the best chance of success, the donor heart has to be transplanted within four hours of being removed from the donor.

When the medical team has confirmed the heart is suitable, you will be given a general anaesthetic. The procedure must be carried out as quickly as possible for the transplant to have the best chance of success.