What is a heart transplant?
A heart transplant is a surgical procedure in which a diseased heart is removed and replaced with a healthy heart from a deceased donor. It is the final treatment option for women with end-stage heart failure severe heart failure that has not responded to other treatments including medication, implantable devices, and surgery.
Heart transplants are the third most common transplant procedure in the US, performed in about 2200 patients each year, 25% of them women. Another 2800 patients remain on the waiting list each year, with wait times ranging from a few weeks to as much as 18 months.
Who is eligible for a heart transplant?
Most women with heart failure caused by blood pumping problems (systolic heart failure) respond well to standard treatments and enjoy a long, fulfilling life. However, some continue to have severe heart failure symptoms (Stage D heart failure), requiring frequent hospitalization and sometimes injected medications to keep their heart pumping. These women are candidates for a heart transplant, and account for most transplants performed each year.
A transplant may also be an option for women with inborn heart defects or chest pain caused by lack of blood flow to the heart that cannot be fixed by bypass surgery or angioplasty. Women with severe heart rhythm problems that do not respond to treatment with a pacemaker or ICD may also be eligible for a transplant.
What is the prognosis of women who receive a heart transplant?
Heart transplant recipients generally do very well: 86% of women survive for at least a year (88% of men) and 69% survive for five years or more (73% of men). Some studies find that after 5 years women tend to have better outcomes than men.
Most women who receive heart transplants enjoy an improved quality of life, with fewer symptoms and a greater ability to perform daily tasks. Many transplant recipients are even able to return to work within a year after the procedure.
What determines who gets a transplant, and what is the waiting process like?
Women with end-stage heart failure who need a heart transplant will be referred to a transplant center to be evaluated as a candidate. There are 130 hospitals in the US that perform heart transplantation’s. Because only a limited supply of donor hearts are available each year, women who need a heart transplant must go through a careful selection process. A candidate must be:
- Sick enough to need a new heart, yet healthy enough to survive the transplant procedure and benefit from the transplant
- Willing and able to follow the medication and recovery program
- Mentally stable enough to handle the stressful wait for a donor heart and long recovery process
- All centers require that patients quit smoking. If they suspect you have a drinking problem you will also be required to stop drinking alcohol for at least 6 months before being considered for a transplant
Doctors at the transplant center will interview and examine you to determine your eligibility for a transplant. If you are accepted you will be placed on a waiting list until a donor heart becomes available. Each year about 2200 heart transplants are performed, and another 2800 patients (25% of them women) remain on the waiting list. Wait times range from a few weeks to 18 months; how long you wait depends on:
- The availability of donor hearts in your area
- How urgently you need a transplant
- How long you have already been waiting
- Your body size and blood, tissue, and immune antibody types (doctors try to match the donor and recipient as closely as possible)
- Your age (younger patients in good general health are likely to benefit most from a transplant, but being over 60 does not mean you won’t receive one)
- Your sex (women do equally well whether they receive a male or female heart, but men older than 45 are better off receiving a heart from a male donor)
Because most patients awaiting a heart transplant are very ill, between 10% and 20% will die before the transplant can be carried out. To “buy time” while waiting for a donor heart to become available, some women may receive a surgically implanted mechanical pump (LVAD) that helps maintain the pumping ability of a heart that can’t work well enough on its own. In women who are not eligible for a transplant, an LVAD can serve as a final treatment, allowing patients to live independently and even return to work.