Heart transplant surgery

If the transplant team determines that you would be a good candidate for heart transplant, you will be “listed for transplant” in the national waiting list maintained by the United Network of Organ Sharing (UNOS).

In the United States, the system for allocating adult heart transplants is based on how sick you are and how well the transplant team believes you’ll do after receiving a transplant. Each transplant candidate is assigned a medical urgency status by their hospital’s transplant program based on specific medical criteria. As a candidate, your status may change over time depending on your health and the treatment(s) you're receiving.

As of 2018, there are six status levels. If you are listed Status 1 or Status 2, you are considered to be in the most urgent need of a heart transplant. You will be considered before patients with Status 3 through Status 6 for heart offers from a much wider geographic area than under the former system — up to 500 miles from the donor’s location.

Learn more about the heart allocation system by visiting UNOS.

Yes, this is called a multiple listing and is permitted by the UNOS. You may increase your chances of getting a heart sooner if you are listed at another heart transplant center in another location. To do so, you will need to be evaluated, accepted by that center and provide verification that your insurance company will pay for another evaluation at another center.

Changes can occur, be it your insurance changes, you need to move or you want to receive your transplant elsewhere. Your "time on the list" can be transferred to another center. Your transplant coordinator can explain the process if this becomes necessary.

It is not possible to predict how long you will have to wait for a donor heart. Some patients wait days while others wait weeks, months or years. Organ offers are made on the basis of:

• Blood type (the donor heart must come from a donor with the same or compatible blood type as you)

• Heart size

• UNOS status

• Waiting time (how long you've been on the waiting list)

While you are waiting for your donor heart, it is important to stay healthy so that when a donor heart does become available, you are in the best possible condition to undergo transplant surgery.

As a transplant candidate, you must notify your transplant team if:

• There are any changes in your medical condition (for example, you start to feel worse)

• You become sick with an illness (common cold, etc.)

• You leave the county for any reason

• Your automatic implantable cardioverter defibrillator (AICD) generator has been changed (if you have one)

• Your contact information changes

• You receive a blood transfusion at another hospital

• Your insurance changes

If your health insurance changes while you are on the list, approval for heart transplantation must be obtained from your new insurance provider.

Once a physician identifies a hospitalized patient with a devastating brain injury, the patient will undergo extensive neurological testing. If the result of this testing is irreversible brain death with no chance of recovery, the local organ procurement organization (OPO) will be called. An OPO professional trained in discussing organ donation will speak to the family about possible organ donation. Procurement coordinators also work for the OPO and are well-trained individuals who work in hospitals with the donor patient to ensure the patient is in good condition for organ donation. The procurement coordinator also ensures the fair and equitable distribution of acceptable donor organs to transplant candidates.

San Diego's local OPO is Lifesharing. Most donors come from the local and regional OPOs located in Northern California, Arizona, Washington, Oregon, Nevada and New Mexico.

When a donor heart becomes available that we believe would be suitable for you, the Sharp transplant team will call you at home and on your cell phone. Since it is not possible to predict when a heart will become available and there is limited time to recover the organ successfully, it is very important that we locate you quickly and get you into the hospital in a timely fashion.

Yes. These factors could include, but are not limited to:

• Infection in the donor that is not detected by the pretransplant screening (e.g., HIV, hepatitis or other infectious disease)

• The condition of the donor heart

• The donor's health history

You will need to take medications for the rest of your life to prevent your body from rejecting your new heart. In addition to looking for rejection, your blood work will be evaluated to determine if the medications are too strong for you and need to be adjusted.

We will teach you the symptoms of rejection so you will know when to call us. We will schedule you for biopsies and echocardiograms after you receive your new heart. The biopsy can tell us about rejection when it is in your cells. The echocardiogram will show any decrease in heart function. If the biopsy or echocardiogram shows you are having a rejection, your medication doses may be increased or new medications may be given.

The medications to decrease the risk of rejection also increase the risk of infection. Your body knows that the new heart does not have your special identification marks — it thinks the new heart is an invader. Therefore, we have to suppress the body's urge to reject the new heart, which can also suppress its reaction to bacteria, viruses and other sources of infection.

Organ transplantation can also impact your psychological well-being. You should be aware that this impact can lead to depression, anxiety, posttraumatic stress disorder, sleep disorders and guilt.

The transplant coordinators and doctors are on call 24 hours a day, seven days a week. You may call the heart transplant program office at 858-939-3831, 7 am to 3 pm, or after hours at 858-939-3400 and ask for the on-call heart transplant coordinator.

Many heart recipients return to work within several months after their transplant. When you return to work depends on how you feel and the type of work you will be doing. Our transplant team of doctors, nurses and social workers can help you with deciding when you can return to work.

Transplant is not for everyone, and everyone who is referred for a transplant may not need one. If you do not think you want to have a transplant, we will respect that decision and assist you with other options.

Even if you are listed for a transplant, you may not get one if you become too sick. We would like for you and your family to consider what you would like to do, or have done, if that happens. It is important that your family and caregivers know your wishes.

You can learn more about the heart transplant process by visiting the Organ Procurement and Transplantation Network (OPTN).