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Before the transplant

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Heart transplant surgery has no fixed date or time. When the hospital receives a heart, all the patients who are eligible to receive it are reviewed and the best candidate is selected. The patient is contacted immediately and told to come to the hospital, where they start on immunosuppressive medication.

Simultaneously, an "extraction" is organised, for which a team of surgeons and perfusionists is transferred to the donor hospital to make sure that the heart is valid, and take it as quickly as possible to the centre where it will be transplanted.

Once the condition of the heart has been validated, the recipient is moved to the operating room and the surgery takes place.

Heart transplant

A heart transplant is done via a median sternotomy: the sternum (breastbone) is cut in half and the patient is attached to a heart-lung machine. During the surgery, the patient’s pacemaker or defibrillator is removed. The operation takes about 4-5 hours.

After surgery

After surgery, the patient is transferred to the Intensive Care Unit. Once there, analyses, x-rays, and EKGs are performed, and then the patient is put on immunosuppressants.

After a few hours, sedation is stopped, and the patient is woken up. Once awake, they must try to sit in a chair and start physiotherapy and rehabilitation as soon as possible. After a few days in ICU, the patient is moved to step-down care in a conventional ward, where they continue the rehabilitation process. The immunosuppressive medication is periodically monitored and the dose adjusted when necessary. In addition, echocardiograms are taken to monitor the new heart’s function. Before being discharged, the patient has a biopsy to rule out rejection.

After the transplant

Once discharged, the patient has to periodically visit the transplant team during the first year. In the first 6 months, they will have control biopsies and analyses, including immunosuppression tests, echocardiograms, and chest x-rays. These controls are designed to detect rejection, if this occurs, in sufficient time. Rejection is treated with corticosteroids and the immunosuppressive medication is adjusted.

It is also necessary to check that no infections occur after the transplant. To avoid infection, preventive treatment is administered in the first month after the transplant. After the first few months, the medication can be reduced because the risk of both infection and rejection is lower. Once a year has passed, the medication is simplified; visits become twice yearly and take place in outpatient clinics.

When the patient needs tests to check the medication in their blood, they should not take the tablets because this could affect the results, but they should start taking them again once their blood has been taken.

The patient should always tell the transplant nursing team if they have any questions or health problems, either by telephone or email, or they may visit the outpatient clinic.

Taking the right medication is the cornerstone of successful transplants. Never stop taking the medication or add other medicines without consulting the transplant team. All patients have to take a lot of medication in the first few months, but this decreases over time. If a patient experiences any side effects when taking the medication, they should consult the medical team but not stop the treatment, as this may cause problems.

There are medicines that can interfere with immunosuppressive drugs. These are known as 'incompatible drugs'. The patient should, therefore, tell their medical team about any changes in their medication made by anyone other than their specialist. Also, the patient should not take any medication of their own accord. Each medicine should be taken according to a specific schedule, particularly the immunosuppressants. If the patient misses a dose, they should not add it to the next day's dose, but they may take it later, on the same day.

Taking the right medication

In order to follow the medical guidelines correctly:

Learn the name of each medicine and what it is for.
Always check the dose, time, and days it must be taken.
Take the medication exactly as instructed by the medical team.
Always have at least one spare box of each medicine at home.
Always keep the medication neatly stored, in a clean dry place, protected from light, heat, and humidity.
Do not save empty or out-of-date bottles or boxes.
Do not change the box the tablets are in or put them together with others.
If you experience unexpected effects such as vomiting, hives, headache, stomach pain, and so on, make a note of these and inform the transplant specialist.
If you take the wrong dose of medicine, do not attempt to correct this in the next dose. Make a note of it and explain what happened in the next visit.
Do not take any new medication without first notifying your medical team.
If you miss a dose, take it as soon as possible and take the next dose according to the previously established schedule.