Advanced heart failure care
Heart
Transplantation
A heart transplant replaces a failing heart with a healthy donor heart. It offers a new chapter of life—and begins a lifelong partnership with the transplant team.
The transplant pathway
From advanced heart failure to a new chapter.
The details differ for every person and transplant program, but the pathway usually follows six connected stages.
Referral
Advanced heart failure remains severe despite optimized therapy.
Evaluation
Medical, surgical and psychosocial assessment determines suitability.
Waiting
Health is supported and monitored while an appropriate donor is sought.
Transplant
The failing heart is removed and the donor heart is connected.
Recovery
Intensive monitoring, rehabilitation and education begin immediately.
Lifelong care
Anti-rejection medication and surveillance protect the graft.
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Whole-person assessment
Evaluation is more than a heart test.
The goal is to determine whether transplantation offers meaningful benefit and whether risks can be managed safely.
Disease severity
Symptoms, heart function, pulmonary pressures, prior surgery and response to advanced therapies.
Overall health
Kidney, liver, lung, infection and cancer screening, nutrition, frailty and rehabilitation potential.
Compatibility
Blood group, HLA antibodies, sensitization and other factors used when assessing donor offers.
Readiness and support
Medication adherence, mental health, caregivers, logistics, finances and informed consent.
The transplant operation
One coordinated sequence.
Specialist teams synchronize donor retrieval, recipient preparation, implantation and early graft support.
Donor heart assessment
The donor organ is evaluated for suitability and compatibility with the recipient.
Recipient preparation
Cardiopulmonary bypass supports circulation while the failing heart is removed.
Implantation
The donor heart is connected to the atria and great vessels using established surgical techniques.
Reperfusion and support
The new heart is carefully reperfused, assessed and supported during the transition off bypass.
The exact surgical approach and postoperative support depend on anatomy, previous operations, donor-recipient factors and intraoperative findings.
After transplantation
Three priorities protect the new heart.
Medication, surveillance and rehabilitation work together. None can replace the others.
Control rejection
Immunosuppressive medicines must be taken exactly as prescribed. Never change a dose without the transplant team.
Drug levels and side effects require regular review.Find problems early
Clinic visits, blood tests, imaging and graft surveillance vary with time after transplant and individual risk.
Rejection can sometimes occur without symptoms.Rebuild strength
Nutrition, progressive activity, cardiac rehabilitation, sleep and emotional support help restore daily life.
Recovery is gradual and individual.
Success continues beyond the hospital.
Most routines become part of ordinary life: taking medicines on time, attending appointments, staying active, preventing infection and contacting the transplant team early when something changes.
Use a schedule, refill early and carry an updated medicine list.
Hand hygiene, food safety, vaccination planning and prompt reporting of fever.
Record temperature, weight, blood pressure and symptoms as advised.
Immunosuppression increases certain risks; follow the program’s prevention plan.
Maintain oral health and coordinate procedures or antibiotics with the team.
Check before new medicines, supplements, vaccines or travel.
Prepare for discharge and follow-up
Six questions every recipient should answer.
What are my immunosuppressant names, doses and exact times?
Which medicines, supplements and foods may interact?
Which symptoms require an immediate call?
What should I monitor and record at home?
When are my next blood tests, imaging and surveillance visits?
Who should I contact after hours or while travelling?
Frequently asked questions
Clear answers to common concerns.
Will I need anti-rejection medication for life?+
Usually yes. The regimen may change over time, but immunosuppression is generally lifelong. Stopping medication can cause rejection.
Can rejection happen without symptoms?+
Yes. That is why scheduled surveillance remains important even when you feel well.
Can I travel after transplant?+
Many recipients travel after recovery. Timing, vaccines, medication supply, infection precautions and access to care should be planned with the transplant team.
When can I return to work or exercise?+
Recovery varies. The transplant and rehabilitation teams should guide progressive activity and return to work.
Can I miss or delay one immunosuppressant dose?+
Do not make that decision alone. Follow your program’s missed-dose instructions and contact the transplant team promptly if a dose is missed, delayed or vomited.
Contemporary transplant care
The page structure reflects the 2024 ISHLT candidate guideline and the 2023 ISHLT recipient-care guideline: multidisciplinary evaluation, collaborative care while waiting, perioperative management, immunosuppression, rejection surveillance, prevention and long-term shared care.