We are committed to ensuring that our heart transplant recipients and their families are as comfortable as possible and have a positive experience.
One of the things that distinguishes our transplant program from those at other academic hospitals is our flexibility and willingness to accommodate your individual needs.
Below are answers to some questions many patients ask our transplant staff. Click on a question below for an answer to a specific question, or scroll down to view the complete list of questions and answers.
If you have any other questions, contact the University of Maryland Heart
Center by calling 410-328-6622.
A heart transplant is a surgical procedure for selected patients whose hearts are so severely damaged that medications, pacing devices, and surgical repair cannot help. A donated heart is transplanted into the patient to replace the damaged heart.
While the patient is deep asleep and pain-free (general anesthesia), an incision is made through the breastbone. The patient's blood is re-routed through tubes to a heart-lung bypass machine to keep the blood oxygen-rich and circulating. The patient's diseased heart is removed and the donor heart is stitched in place.
When surgery is completed you will be taken to the intensive care unit. Over the following days as you recover from surgery, the various tubes and intravenous lines will gradually be removed and rehabilitation will begin. You will be closely monitored and evaluated to make sure your body is accepting the new organ. This includes regular heart echocardiograms, electrocardiograms and biopsies.
During this time, the cardiac surgeon, cardiologist and other transplant team members will be looking very carefully for any signs of heart rejection or infection. Medications that suppress the body's natural immune system will be administered to counter the body's tendency to reject the new heart. These medications have dramatically reduced the number of rejections.
Although you are unlikely to be very active in the first couple of days, you should be able to walk around in just three or four days. Once you are discharged from the hospital, our medical team will encourage you to become increasingly active. They will provide regular medical support, including frequent visits, blood tests, and regular "protocol" biopsies to be sure there is no rejection of the new heart. Other diagnostic tests will be performed between one and several times a year depending on your particular situation.
The average length of stay in the intensive care unit is 3-7 days, followed by 1-2 weeks in the hospital.
While waiting, you will be seen in the clinic periodically to assist with any medical issues that may arise. Almost every patient will need to have a right heart catheterization and other tests every three to four months. These tests are important to help us know whether problems are developing that could complicate a transplant, or move you ahead in priority for a new heart.
All candidates for transplantation begin the program with a comprehensive series
of tests conducted by our multidisciplinary team of specialists. Some of these
tests are required for any operative procedure while others are required especially
for transplantation surgery.
Once the evaluation is complete, the transplant team will decide if heart transplant is the best option. The risks and benefits will be discussed with each patient. If the patient and transplant team agree that transplantation is the best choice, the patient is then placed on the transplant waiting list at the University of Maryland.
The heart transplant waiting list is organized through the United Network for Organ Sharing (UNOS), which is the national list. To be on the list means that your name and important medical criteria are kept on UNOS' nationwide computer database. This database automatically matches a donor with potential recipients. Once listed, you may be called at any time, day or night, to come directly to the hospital for a transplant.
Waiting time for a new heart varies by blood type, recipient size and weight and by "status". The status system reflects an effort to a measure a patient's risk of dying soon, and to assure that patients with the most severe heart failure symptoms get priority when a donor heart becomes available. The average waiting time in Maryland is currently about 18 months for patients who are healthy enough to wait at home for their new heart. The wait is somewhat shorter for patients who require hospitalization or intravenous medicines, or insertion of a blood pump.
The donor heart is matched to the recipient based on compatibility of blood type, body size (donor compared to recipient) and urgency of need. Other factors may be taken into account, such as resistance to blood flow through the lung arteries, where a larger or stronger heart may be necessary to push blood through the lungs, and for the transplant to succeed.
Yes. You can resume a normal life while following a strict medical regimen. You may return to work and a normal lifestyle. You will need to take some precautions to avoid unnecessary exposure to infection. You will also need to take a large variety of medications to prevent rejection of the new heart, and to prevent or manage common side effects and complications of the anti-rejection medicines.
Initially, follow-up care involves returning to the outpatient clinic once a week for the first month after leaving the hospital. At this time a series of tests are given to closely monitor your progress. At this time, medications will be precisely adjusted. After this initial period, patients will be seen periodically (bi-weekly, then monthly, then quarterly) over the first year. Thereafter scheduled visits occur less often, depending on the particular patient's condition.
Yes. This is very important. It is necessary for all patients to take immunosuppressive medications for the rest of their lives following transplant, because the medications help to prevent rejection of the heart. Unfortunately, it is very rare that a patient becomes "tolerant" of their new heart. A successful transplant can be undermined very quickly if patients fail to take their medications appropriately and responsibly.
If the immune system is able to attack the transplanted heart, it is called rejection. Rejection must be detected and treated quickly to prevent damage to the transplanted heart. After a transplant, you are given the symptoms of rejection to look for and appointments are scheduled regularly with your doctor for checkups and myocardial biopsies to help detect rejection.
What are immunosuppressive drugs?
To help prevent transplant failure, heart transplant recipients are prescribed immunosuppressive drugs. These drugs inhibit the body's immune system from identifying the new organ as foreign. Transplantation has become so successful in recent years because of the development of new, more effective drugs that prevent rejection by the body of donated organs.
Heart transplant recipients are more likely to develop coronary artery disease (CAD). This disease is thought to be part of the slow rejection process in the transplanted hearts. About 50 percent of heart-transplant patients develop CAD. Therefore, patients must undergo a cardiac catheterization test periodically to check for the disease. We hope that newer anti-rejection medicines will reduce the frequency and severity of this problem for our current patients.
We have performed 13 transplants in the past 9 months, after a period when
relatively few transplants were done due to transition in the surgical team.
The UMMC program has performed over 70 heart transplants.
The current surgical team at UMMC has a cumulative experience with performing over 700 heart, lung, and heart-lung transplants, with individual outcome statistics that are among the best in the world.
Historically, over 80% of patients transplanted here survived for over one year after surgery, a record of success similar to benchmarks from the International Society for Heart and Lung Transplant Registry database. In the past year, every patient transplanted has survived surgery, and all have been able to return home and to a relatively normal life. As of this writing, all are doing well.
University of Maryland did its first heart transplant in 1990, and the longest-surviving patient recently passed his 12th anniversary of the Gift of Life.
There are no simple answers to this question. First, you must answer some questions yourself. Do you have insurance? If so, you must read your policy book. If you do not have one, contact your broker who sold you the policy or contact your employer benefits unit. This is your transplant and you need to be involved in learning about many aspects of transplant, including insurance.
Review your plan to answer the following questions:
There are as many different insurance plans as there are patients, so we can't discuss all the details here. Our finance coordinators and other benefits staff can work with you, but we expect you to do the basic research about your insurance.
As explained above, this must be determined on a case-by-case basis. The transplant staff will direct you to the appropriate benefits contact person. The transplant financial counselor checks each patient's insurance.
The University of Maryland Medical Center's Heart Transplant Program has been certified by Medicare and Medicaid since June 2003.
There are several phases in the transplant process. It may be helpful to break down these costs by looking at these phases. The first costs are those associated with the pre-transplant evaluation, which would include all the tests necessary to determine if you qualify to be on the waiting list. There may be costs of hospital admission for medical treatment and stabilization before your transplant.
After that, when you are called in for your organ transplant, you will incur
the costs of hospitalization, transplant surgery and various professional and
facility fees. Before you are discharged home you will begin to generate fees
for home nursing visits if needed, a schedule of lab testing and a long list
of medications. Subsequent costs will include ongoing evaluation of your overall
health and organ functioning and lifetime follow-up at the Medical Center.
Due to the wide variety of patient conditions and treatments, it's very difficult to give an average total cost for the aforementioned treatments. Each case and each patient's condition is different.
If you or your spouse is employed and entitled to enroll in an insurance program
at work and you have not yet enrolled, we urge you to purchase that coverage
immediately. If you are self-employed, all participating insurers in the state
of Maryland offer open enrollment periods twice a year. You should purchase
that insurance as soon as possible. For more information, contact the Maryland
You must explore all other benefits programs by making applications for:
If you do not qualify for any of these programs, there are several national foundations that can assist patients and their families in developing a fundraising strategy and managing the money. Keep in mind that these are professional fundraising advisors; they do not give money to transplant patients.