A heart transplant, or a cardiac transplant, is a

surgical Surgery is a medical specialty that uses manual and instrumental techniques to diagnose or treat pathological conditions (e.g., trauma, disease, injury, malignancy), to alter bodily functions (e.g., malabsorption created by bariatric surgery ...

transplant procedure performed on patients with end-stage

heart failure Heart failure (HF), also known as congestive heart failure (CHF), is a syndrome caused by an impairment in the heart's ability to Cardiac cycle, fill with and pump blood. Although symptoms vary based on which side of the heart is affected, HF ...

when other medical or surgical treatments have failed. , the most common procedure is to take a functioning

heart The heart is a muscular Organ (biology), organ found in humans and other animals. This organ pumps blood through the blood vessels. The heart and blood vessels together make the circulatory system. The pumped blood carries oxygen and nutrie ...

from a recently deceased organ donor (

brain death Brain death is the permanent, irreversible, and complete loss of Electroencephalography, brain function, which may include cessation of involuntary activity (e.g., Control of ventilation#Control of respiratory rhythm, breathing) necessary to su ...

is the most common) and implant it into the patient. The patient's own heart is either removed and replaced with the donor heart ( orthotopic procedure) or, much less commonly, the recipient's diseased heart is left in place to support the donor heart (heterotopic, or "piggyback", transplant procedure). Approximately 5,000 heart transplants are performed each year worldwide, more than half of which are in the US. Post-operative survival periods average 15 years. Heart transplantation is not considered to be a cure for heart disease; rather it is a life-saving treatment intended to improve the quality and duration of life for a recipient.

History

American medical researcher Simon Flexner was one of the first people to mention the possibility of heart transplantation. In 1907, he wrote the paper "Tendencies in Pathology," in which he said that it would be possible one day by surgery to replace diseased human organs – including arteries, stomach,

kidneys In humans, the kidneys are two reddish-brown bean-shaped blood-filtering organs that are a multilobar, multipapillary form of mammalian kidneys, usually without signs of external lobulation. They are located on the left and right in the retro ...

and heart. Not having a human donor heart available, James D. Hardy of the University of Mississippi Medical Center transplanted the heart of a chimpanzee into the chest of dying Boyd Rush in the early morning of Jan. 24, 1964. Hardy used a defibrillator to shock the heart to restart beating. This heart did beat in Rush's chest for 60 to 90 minutes (sources differ), and then Rush died without regaining consciousness.''Every Second Counts: The Race to Transplant the First Human Heart'', Donald McRae, New York: Penguin (Berkley/Putnam), 2006
Ch. 7 "Mississippi Gambling"
pp. 123–27. This source states the heartbeat for approximately one hour.
Obituary, ''New York Times'' (Associated Press), Feb. 21, 2003. This source states the transplanted chimpanzee heartbeat for 90 minutes. Although Hardy was a respected surgeon who had performed the world's first human-to-human lung transplant a year earlier, See also in same issue.Second Wind: Oral Histories of Lung Transplant Survivors
Mary Jo Festle, Palgrave MacMillan, 2012. author Donald McRae states that Hardy could feel the "icy disdain" from fellow surgeons at the Sixth International Transplantation Conference several weeks after this attempt with the chimpanzee heart.''Every Second Counts'', McRae
page 126, top
Hardy had been inspired by the limited success of Keith Reemtsma at

Tulane University The Tulane University of Louisiana (commonly referred to as Tulane University) is a private research university in New Orleans, Louisiana, United States. Founded as the Medical College of Louisiana in 1834 by a cohort of medical doctors, it b ...

in transplanting chimpanzee kidneys into human patients with kidney failure. ' … the consent form for Hardy's operationwhich, in view of the patient's semi-comatose condition, was signed by a close relativestipulated that no heart transplant had ever been performed, but made no mention of the fact that an animal heart might be used for the procedure. Such was the medicolegal situation at that time that this "informed" consent was not considered in any way inadequate. . ' The consent form Hardy asked Rush's stepsister to sign did not include the possibility that a chimpanzee heart might be used, although Hardy stated that he did include this in verbal discussions.''Xenotransplantation: Law and Ethics'', Sheila McLean, Laura Williamson, University of Glasgow, UK, Ashgate Publishing, 2005
p. 50
A xenotransplantation is the technical term for the transplant of an organ or tissue from one species to another. Dr Dhaniram Baruah of

Assam Assam (, , ) is a state in Northeast India, northeastern India, south of the eastern Himalayas along the Brahmaputra Valley, Brahmaputra and Barak River valleys. Assam covers an area of . It is the second largest state in Northeast India, nor ...

, India was the first heart surgeon to transplant a pig's heart in human body. However the recipient died subsequently. The world's first successful pig-to-human heart transplant was performed in January 2022 by surgeon Bartley P. Griffith of USA. The world's first human-to-human heart transplant was performed by

South Africa South Africa, officially the Republic of South Africa (RSA), is the Southern Africa, southernmost country in Africa. Its Provinces of South Africa, nine provinces are bounded to the south by of coastline that stretches along the Atlantic O ...

n cardiac surgeon Christiaan Barnard utilizing the techniques developed by American surgeons Norman Shumway and Richard Lower. McRae, D. (2006). ''Every Second Counts: The Race to Transplant the First Human Heart'', New York: Penguin (Berkley/Putnam). Patient Louis Washkansky received this transplant on December 3, 1967, at the

Groote Schuur Hospital Groote Schuur Hospital is a large government-funded teaching hospital situated on the slopes of Devil's Peak (Cape Town), Devil's Peak in the city of Cape Town, South Africa. It was founded in 1938 and is famous for being the institution where ...

Cape Town Cape Town is the legislature, legislative capital city, capital of South Africa. It is the country's oldest city and the seat of the Parliament of South Africa. Cape Town is the country's List of municipalities in South Africa, second-largest ...

, South Africa. Washkansky, however, died 18 days later from

pneumonia Pneumonia is an Inflammation, inflammatory condition of the lung primarily affecting the small air sacs known as Pulmonary alveolus, alveoli. Symptoms typically include some combination of Cough#Classification, productive or dry cough, ches ...

. On December 6, 1967, at Maimonides Hospital in Brooklyn, New York, Adrian Kantrowitz performed the world's first

pediatric Pediatrics (American English) also spelled paediatrics (British English), is the branch of medicine that involves the medical care of infants, children, adolescents, and young adults. In the United Kingdom, pediatrics covers many of their youth ...

heart transplant. The infant's new heart stopped beating after 7 hours and could not be restarted. At a following press conference, Kantrowitz emphasized that he did not consider the operation a success.''Heart: An American Medical Odyssey'', Dick Cheney, Richard B. Cheney, Jonathan Reiner, MD, with Liz Cheney, Scribner (division of Simon & Schuster), 2013
"Three days later, on December 6, 1967, Dr. Adrian Kantrowitz"
/ref> Norman Shumway performed the first adult heart transplant in the United States on January 6, 1968, at the Stanford University Hospital. A team led by Donald Ross performed the first heart transplant in the United Kingdom on May 3, 1968. These were allotransplants, the technical term for a transplant from a non-genetically identical individual of the same species. Worldwide, more than 100 transplants were performed by various doctors during 1968. Only a third of these patients lived longer than three months.The Adrian Kantrowitz Papers, Replacing Hearts: Left Ventricle Assist Devices and Transplants, 1960–1970
National Institutes of Health, U.S. National Library of Medicine. The next big breakthrough came in 1983 when

cyclosporine Ciclosporin, also spelled cyclosporine and cyclosporin, is a calcineurin inhibitor, used as an immunosuppressant medication. It is taken orally or intravenously for rheumatoid arthritis, psoriasis, Crohn's disease, nephrotic syndrome, ecz ...

entered widespread usage. This drug enabled much smaller amounts of

corticosteroid Corticosteroids are a class of steroid hormones that are produced in the adrenal cortex of vertebrates, as well as the synthetic analogues of these hormones. Two main classes of corticosteroids, glucocorticoids and mineralocorticoids, are invo ...

s to be used to prevent many cases of rejection (the "corticosteroid-sparing" effect of cyclosporine).Transplantation of the heart: An overview of 40 years' clinical and research experience at Groote Schuur Hospital and the University of Cape Town
''South African Medical Journal'', "Part I. Surgical experience and clinical studies." J Hassoulas, Vol. 102, No. 6 (2012). On June 9, 1984, "JP" Lovette IV of

Denver Denver ( ) is a List of municipalities in Colorado#Consolidated city and county, consolidated city and county, the List of capitals in the United States, capital and List of municipalities in Colorado, most populous city of the U.S. state of ...

Colorado Colorado is a U.S. state, state in the Western United States. It is one of the Mountain states, sharing the Four Corners region with Arizona, New Mexico, and Utah. It is also bordered by Wyoming to the north, Nebraska to the northeast, Kansas ...

, became the world's first successful pediatric heart transplant. Columbia-Presbyterian Medical Center surgeons transplanted the heart of 4-year-old John Nathan Ford of Harlem into 4-year-old JP a day after the Harlem child died of injuries received in a fall from a fire escape at his home. JP was born with multiple heart defects. The transplant was done by a surgical team led by Dr. Eric A. Rose, director of cardiac transplantation at New York–Presbyterian Hospital. Drs. Keith Reemtsma and Fred Bowman also were members of the team for the six-hour operation. In 1988, the first "domino" heart transplant was performed, in which a patient in need of a lung transplant with a healthy heart would receive a heart-lung transplant, and their original heart would be transplanted into someone else. Worldwide, about 5,000 heart transplants are performed annually, an increase of 53 percent between 2011 and 2022. The majority of these are performed in the United States (over half). Vanderbilt University Medical Center in

Nashville, Tennessee Nashville, often known as Music City, is the capital and List of municipalities in Tennessee, most populous city in the U.S. state of Tennessee. It is the county seat, seat of Davidson County, Tennessee, Davidson County in Middle Tennessee, locat ...

currently is the largest volume heart transplant center in the world, completing 174 transplants in 2024, though this title changes frequently. About 800,000 people have NYHA Class IV heart failure symptoms indicating advanced heart failure. The great disparity between the number of patients needing transplants and the number of procedures being performed spurred research into the transplantation of non-human hearts into humans after 1993. Xenografts from other species and

artificial heart An artificial heart is a artificial organ, device that replaces the human heart, heart. Artificial hearts are typically used as a bridge to heart transplantation, but ongoing research aims to develop a device that could permanently replace the ...

s are two less successful alternatives to

allograft Allotransplant (''allo-'' meaning "other" in Ancient Greek, Greek) is the Organ transplant, transplantation of cell (biology), cells, Biological tissue, tissues, or Organ (anatomy), organs to a recipient from a genetically non-identical donor of ...

s. The ability of medical teams to perform transplants continues to expand. For example,

Sri Lanka Sri Lanka, officially the Democratic Socialist Republic of Sri Lanka, also known historically as Ceylon, is an island country in South Asia. It lies in the Indian Ocean, southwest of the Bay of Bengal, separated from the Indian subcontinent, ...

's first heart transplant was successfully performed at the Kandy General Hospital on July 7, 2017. 2032 Automatic Innervation

During heart transplant, the

vagus nerve The vagus nerve, also known as the tenth cranial nerve (CN X), plays a crucial role in the autonomic nervous system, which is responsible for regulating involuntary functions within the human body. This nerve carries both sensory and motor fibe ...

is severed, thus removing

parasympathetic The parasympathetic nervous system (PSNS) is one of the three divisions of the autonomic nervous system, the others being the sympathetic nervous system and the enteric nervous system. The autonomic nervous system is responsible for regulat ...

influence over the

myocardium Cardiac muscle (also called heart muscle or myocardium) is one of three types of vertebrate muscle tissues, the others being skeletal muscle and smooth muscle. It is an involuntary, striated muscle that constitutes the main tissue of the wall o ...

. However, some limited return of sympathetic nerves has been demonstrated in humans. Recently, Australian researchers found a way to give more time for a heart to survive prior to the transplant, almost double the time. Heart transplantation using donation after circulatory death (DCD) was recently adopted and can help in reducing waitlist time while increasing transplant rate. Critically ill patients that are unsuitable for heart transplantation can be rescued and optimized with mechanical circulatory support, and bridged successfully to heart transplantation afterwards with good outcomes. On January 7, 2022, David Bennett, aged 57, of Maryland became the first person to receive a gene-edited pig heart in a transplant at the

University of Maryland Medical Center The University of Maryland Medical Center (UMMC) is a teaching hospital with 789 beds based in Baltimore, Maryland, that provides the full range of health care to people throughout Maryland and the Mid-Atlantic region. It gets more than 26,000 inp ...

. Before the transplant, David was unable to receive a human heart due to the patient's past conditions with heart failure and an irregular heartbeat, causing surgeons to use the pig heart that was genetically modified. Bennett died two months later at University of Maryland Medical Center on March 8, 2022. On April 19, 2023 Stanford Medicine surgeons performed the first beating-heart transplants from cardiac death donors.

Contraindications

Some patients are less suitable for a heart transplant, especially if they have other circulatory conditions related to their heart condition. The following conditions in a patient increase the chances of complications. Absolute contraindications: * Irreversible

kidney In humans, the kidneys are two reddish-brown bean-shaped blood-filtering organ (anatomy), organs that are a multilobar, multipapillary form of mammalian kidneys, usually without signs of external lobulation. They are located on the left and rig ...

lung The lungs are the primary Organ (biology), organs of the respiratory system in many animals, including humans. In mammals and most other tetrapods, two lungs are located near the Vertebral column, backbone on either side of the heart. Their ...

, or

liver The liver is a major metabolic organ (anatomy), organ exclusively found in vertebrates, which performs many essential biological Function (biology), functions such as detoxification of the organism, and the Protein biosynthesis, synthesis of var ...

disease * Active cancer if it is likely to impact the survival of the patient * Life-threatening diseases unrelated to the cause of

, including acute infection or systemic disease such as

systemic lupus erythematosus Lupus, formally called systemic lupus erythematosus (SLE), is an autoimmune disease in which the body's immune system mistakenly attacks healthy tissue in many parts of the body. Symptoms vary among people and may be mild to severe. Common ...

sarcoidosis Sarcoidosis (; also known as Besnier–Boeck–Schaumann disease) is a disease involving abnormal collections of White blood cell, inflammatory cells that form lumps known as granulomata. The disease usually begins in the lungs, skin, or lymph n ...

, or

amyloidosis Amyloidosis is a group of diseases in which abnormal proteins, known as amyloid fibrils, build up in tissue. There are several non-specific and vague signs and symptoms associated with amyloidosis. These include fatigue, peripheral edema, weigh ...

Vascular disease Vascular disease is a class of diseases of the vessels of the circulatory system in the human body, body, including blood vessels – the arteries and veins, and the lymphatic vessels. Vascular disease is a subgroup of cardiovascular disease. Diso ...

of the neck and leg arteries. * High pulmonary vascular resistance – over 5 or 6 Wood units. Relative contraindications: *

Insulin Insulin (, from Latin ''insula'', 'island') is a peptide hormone produced by beta cells of the pancreatic islets encoded in humans by the insulin (''INS)'' gene. It is the main Anabolism, anabolic hormone of the body. It regulates the metabol ...

-dependent

diabetes Diabetes mellitus, commonly known as diabetes, is a group of common endocrine diseases characterized by sustained high blood sugar levels. Diabetes is due to either the pancreas not producing enough of the hormone insulin, or the cells of th ...

with severe organ dysfunction * Recent

thromboembolism Thromboembolism is a condition in which a blood clot (thrombus) breaks off from its original site and travels through the bloodstream (as an embolus) to obstruct a blood vessel, causing tissue ischemia and organ damage. Thromboembolism can affe ...

such as

stroke Stroke is a medical condition in which poor cerebral circulation, blood flow to a part of the brain causes cell death. There are two main types of stroke: brain ischemia, ischemic, due to lack of blood flow, and intracranial hemorrhage, hemor ...

* Severe

obesity Obesity is a medical condition, considered by multiple organizations to be a disease, in which excess Adipose tissue, body fat has accumulated to such an extent that it can potentially have negative effects on health. People are classifi ...

* Age over 65 years (some variation between centers) – older patients are usually evaluated on an individual basis. * Active

substance use disorder Substance use disorder (SUD) is the persistent use of drugs despite substantial harm and adverse consequences to self and others. Related terms include ''substance use problems'' and ''problematic drug or alcohol use''. Along with substance-ind ...

, such as

alcohol Alcohol may refer to: Common uses * Alcohol (chemistry), a class of compounds * Ethanol, one of several alcohols, commonly known as alcohol in everyday life ** Alcohol (drug), intoxicant found in alcoholic beverages ** Alcoholic beverage, an alco ...

, recreational drugs or

tobacco Tobacco is the common name of several plants in the genus '' Nicotiana'' of the family Solanaceae, and the general term for any product prepared from the cured leaves of these plants. More than 70 species of tobacco are known, but the ...

smoking (which increases the chance of lung disease) Patients who are in need of a heart transplant but do not qualify may be candidates for an

or a left ventricular assist device (LVAD).

Complications

Potential complications include: * Post-operative complications include infection and

sepsis Sepsis is a potentially life-threatening condition that arises when the body's response to infection causes injury to its own tissues and organs. This initial stage of sepsis is followed by suppression of the immune system. Common signs and s ...

. The surgery death rate was 5–10% in 2011. * Acute or chronic graft rejection :* Cardiac allograft vasculopathy * Atrial arrhythmia * Lymphoproliferative malignancies, further worsened by immunosuppressive medication * Increased risk of secondary infections due to immunosuppressive medication *

Serum sickness Serum sickness in humans is a adverse drug reaction, reaction to proteins in antiserum derived from a non-human animal source, occurring 5–10 days after exposure. Symptoms often include a rash, Arthralgia, joint pain, fever, and lymphadenopathy. ...

due to anti-thymocyte globulin * Tricuspid valve regurgitation * Repeated endomyocardial biopsy can cause bleeding and thrombosis

Rejection

Since the transplanted heart originates from another organism, the recipient's immune system will attempt to reject it regardless if the donor heart matches the recipient's blood type (unless if the donor is an isograft). Like other solid organ transplants, the risk of rejection never fully goes away, and the patient will be on immunosuppressive drugs for the rest of their life. Usage of these drugs may cause unwanted side effects, such as an increased likelihood of contracting secondary infections or develop certain types of cancer. Recipients can acquire kidney disease from a heart transplant due to the side effects of immunosuppressant medications. Many recent advances in reducing complications due to tissue rejection stem from mouse heart transplant procedures. People who have had heart transplants are monitored in various ways to test for possible organ rejection. A 2022 pilot study examining the acceptability and feasibility of using video directly observed therapy to increase medication adherence in adolescent heart transplant patients showed promising results of 90.1% medication adherence compared to 40-60% typically. Higher medication variability levels can lead to greater organ rejections and other poor outcomes.

Prognosis

The prognosis for heart transplant patients following the orthotopic procedure has improved over the past 20 years, and as of June 5, 2009 the survival rates were:Heart Disease and Stroke Statistics – 2012 Update
''The

American Heart Association The American Heart Association (AHA) is a nonprofit organization in the United States that funds cardiovascular medical research, educates consumers on healthy living and fosters appropriate Heart, cardiac care in an effort to reduce disability ...

''. Retrieved 27 November 2012. * 1 year: 88.0% (males), 86.2% (females) * 3 years: 79.3% (males), 77.2% (females) * 5 years: 73.2% (males), 69.0% (females) In 2007, researchers from the

Johns Hopkins University School of Medicine The Johns Hopkins University School of Medicine (JHUSOM) is the medical school of Johns Hopkins University, a Private university, private research university in Baltimore, Maryland. Established in 1893 following the construction of the Johns Ho ...

discovered that "men receiving female hearts had a 15% increase in the risk of adjusted cumulative mortality" over five years compared to men receiving male hearts. Survival rates for women did not significantly differ based on male or female donors.

References

External links

Orthotopic heart transplantation: the bicaval technique

Heart Treatments - Heart Treatments , NHLBI, NIH
NIH {{DEFAULTSORT:Heart Transplantation Cardiac surgery Organ transplantation