Heart Transplant

What is a heart transplant?

A heart transplant is an operation that replaces a failing heart with a healthy heart from a deceased donor. If a child’s end-stage heart failure is no longer responding to medical treatment, a heart transplant may be an option.

A heart transplant generally improves the overall quality of life for children and their families. It allows children to feel well and to participate in age-appropriate activities.

It is important to remember that transplantation is not a cure. Children and their families are trading a life-limiting heart disease for lifelong medications, close medical follow up, invasive interventions and the side effects of transplantation medications.

Why is a heart transplant recommended?

Generally, the reason for a transplant lies in progressive and untreatable heart failure. A child may have a complex congenital heart disease (abnormal heart structures) or cardiomyopathy (abnormal/ineffective heart muscle) that is causing heart failure. Heart failure is when the heart cannot pump adequately and appropriately (due to abnormal structure or weak heart muscle).

Heart failure can progress and cause an increase in symptoms. Symptoms are different in each child and often depend on how long the heart disorder has been present. As heart failure progresses, your child may require more aggressive assistance and prolonged hospital stays. When all other medical or surgical options have been explored, your physicians may recommend heart transplantation as a treatment option. 

Evaluation for heart transplant

A thorough evaluation is done if doctors determine that a heart transplant might be a treatment option. Consideration for a heart transplant becomes necessary for children who are failing maximal medical therapy and in whom additional cardiac surgery is unlikely to be beneficial.

The primary goals of an evaluation are:

  • to determine a child’s need for transplantation
  • to identify any increased risk or contraindications to heart transplantation
  • to educate the child and family

The evaluation generally takes several days to complete and involves a large number of tests and consultations. Medical tests are performed to determine the extent of cardiac disease and current cardiac function. These tests will help determine if there are any other treatments or medications available that may be considered to help preserve a child’s current cardiac function.

Throughout the many assessments and consultations, the evaluation process is also a time of education. The Boston Children’s Hospital heart transplant team will answer questions and help you begin to plan for the future if your child needs a transplant.

Your transplant team cardiologist and the heart-transplant coordinator are the primary clinicians here at the hospital who will be working with you as you proceed through the evaluation. They will also be in close communication with the physicians or cardiologists who have been managing you or your child’s care up until this point in time.

Heart-function tests

Besides routine history and physical examinations, there are a variety of procedures to be sure that heart transplant is the right option.

These tests can include:

A child will also likely undergo  extensive blood work as well as ultrasounds, nuclear medicine studies and bone-density tests.

The drugs used after transplant effect many other organs in the body (especially the kidneys, liver and nervous system), so baseline information regarding the functioning of other body systems is critical.

Heart transplant team consultations

Potential heart-transplant recipients will meet the members of the multidisciplinary transplant team during evaluation. One of the cardiologists will be identified as a child’s primary physician. In addition, one of the nurse practitioners will become the heart transplant team coordinator. A nutritionist, pharmacist, financial coordinator, social worker, infectious disease physician as well as other hospital specialty personnel will see the child as indicated by the medical condition.

After these consultations and tests, our transplant team will meet as a group to determine whether a child is a good candidate for a heart transplant. Our approach to care ensures that every child’s case will involve thoughtful consideration of every treatment possibility.