Heart Transplant Program

Your Mass General Heart Transplant care team guides you through the process of heart transplantation, including evaluation and pre-transplant care options.

Heart transplantation is reserved for patients who have no alternative treatment options and who are likely to respond well to transplantation. The transplant evaluation process is designed to determine whether you are likely to have a good outcome after your transplant.

Your evaluation will involve multiple tests that may include:

• Advanced imaging studies
• Blood tests
• Colonoscopy
• Heart catheterization, which involves inserting a thin, flexible tube into the right or left side of the heart to diagnose some heart diseases

Your care team will work with you to coordinate your evaluation process. We recommend that you bring a family member or friend to each of your appointments to provide support and help collect information about your care.

If you are found to be a good candidate, you will be placed on a waiting list managed by the United Network for Organ Sharing (UNOS). UNOS is contracted by the federal government to manage the nation's organ transplant system.

UNOS has designed a system to allocate donor organs to potential recipients. Priority is given to the most severely ill patients when matching a donor heart to a waiting patient. This usually means that patients who are hospitalized and require continuous medical therapy to stay alive, and patients with mechanical circulatory support devices that have developed complications affecting device function, are given first access to donor organs.

There are occasions when a patient waiting at home, either without a mechanical support device or with a normally functioning device, will be matched with a donor organ. It is very important that all patients awaiting a donor heart be ready and available should the coordinator or physician contact you to come to Mass General for transplantation. Following the guidelines below is important as you await a donor organ:

• Maintain your health: Be sure to follow your medical regimen and the lifestyle changes your physician team has advised as you await transplantation. Should any evidence of deterioration in your health develop, please contact your transplant coordinator or physician so that this can be addressed prior to being called for a transplant. These symptoms include:
  • Fever
  • Worsening shortness of breath
  • Leg or ankle swelling
  • An infection
  • A hospitalization at another facility
• Be available and reachable: When a donor organ is available, you will receive a call from your coordinator or surgeon asking you to come to Mass General for the transplant. Since this call can come at any time during the day or night, any day of the week, it is important for the transplant team to be able to reach you. You should provide our center with all of your phone numbers, as well as the phone numbers of a few emergency contacts, so that we can contact you when needed
• Have accessible transportation to Mass General: Transportation can be particularly difficult during inclement weather. Please contact the transplant coordinator if you think that you will have difficulty getting to Mass General within four hours at any time while you are awaiting a donor heart

The time that patients spend waiting for a donor heart can be challenging. Do not hesitate to contact your transplant team should you have any questions or concerns during this period. Our transplant cardiologists, coordinators, social worker and psychiatrist will support you throughout the entire transplantation process.

Your care team will work with you and your local physician to address health care issues that may develop as you wait for your transplant. We offer:

• Medications to improve the heart’s function before transplant: We are recognized as world leaders in the development of inhaled nitric oxide and type 5 phosphodiesterase inhibitors to improve the function of the right side of the heart (right ventricle) in pre-transplant patients
• Ventricular assist devices (VADs) to improve patients’ quality of life and functional status before surgery: We were involved in the original research trials of several devices that were granted FDA approval, including HeartMate® Left Ventricular Assist Device (LVAD). We were also part of a multi-institutional study that first showed the positive impact of the continuous flow HeartMate II®. We offer several types of LVAD devices based on individual need
• Minimally invasive implantation procedures: We strive to minimize the number of invasive procedures our patients receive. Our cardiac surgeons are national leaders in minimally invasive implantation procedures for VADs
• Novel research studies: We offer many clinical trials for patients with advanced heart failure including drug trials, stem cell therapy and implantable devices to manage symptoms of heart failure. Learn more about our clinical trials and research program
• Supportive care: Illness and recovery are stressful, and emotional health is an important component of pre-transplant care. Our award-winning cardiac transplant psychiatrist specializes in working with patients to help mitigate the particular stresses facing transplant candidates and their families

Our commitment to your well-being extends to your postoperative care. We will help you arrange for stays at intermediate care facilities, or implement home services, following discharge.

Once you receive your heart transplant at the Massachusetts General Hospital Transplant Center, our team will provide your follow-up care. At the time of your discharge, you will receive extensive instructions for all of your new medications and steps to take to ensure a healthy heart. You should follow your care team’s recommendations on diet, exercise and lifestyle changes. It is important to be your own advocate when you have concerns or questions.

Following transplantation, you will be taking immunosuppression medications daily to prevent your body from rejecting the heart. These drugs reduce your immune system function, so it is equally important to make sure you do not develop any infections after transplant.

Initially, you will be seen once a week in clinic, and you will have cardiac biopsies performed during many of these visits. A cardiac biopsy, also known as heart biopsy, is a procedure in which a small catheter is used to obtain a small piece of heart muscle tissue in order to detect heart disease. Chest X-rays and echocardiograms may be performed at some of these visits. These procedures help us monitor the function of your new heart and guide changes that we will make in your medications. One month after your surgery, these visits may occur every other week for the next two months and less frequently thereafter.

If a biopsy or other test indicates organ rejection, please be reassured that this is very common and does not mean that your new heart will fail. A change or temporary increase in your immunosuppression medication may resolve the rejection.

If for some reason you are unable to take your medications, unable to come to clinic or unable to have your blood drawn, please notify our team immediately so that we may assist you. We have a team on-call 24 hours a day, seven days a week to answer any questions.

In case of an emergency, please proceed to the nearest emergency room and have the doctor there call the Mass General Transplant Center at 617-724-1400. During evenings, nights and weekends, the transplant cardiologist on-call can be reached at 617-726-9292.

General Wellness Tips

• Avoid contact with sick people after surgery
• If someone is sick in your household, wear a surgical mask
• Wash your hands frequently
• Avoid driving until you are off all pain medications and able to move about without any discomfort
• Take walks daily
• Return to work when you feel comfortable
• Avoid heavy lifting for two months following surgery