Heart Transplant Surgery

When your heart failure symptoms become severe and medical treatment no longer helps, you and your doctor might discuss a heart transplant. A heart transplant is a surgical procedure to replace your damaged or diseased heart with a healthy heart from a deceased donor.

Our heart transplant specialists have more than 40 years of experience understanding the medical and support needs of patients and their families. They accept some of the most complex cases and may be able to treat you, even if you have been turned down at another transplant center.

Additionally, UPMC has been recognized by the Scientific Registry of Transplant Recipients (SRTR) as a top transplant program based on outcomes. UPMC is a national leader in 90-day survival rates after heart transplantation and is among the top nationally for patient survival rates at 30 days and one year post-transplant.

Start Your Transplant Journey

What Is Heart Transplant Surgery?

Heart transplant surgery is a procedure to replace your damaged or diseased heart with a healthy heart from a deceased donor. It is performed to treat end-stage heart failure caused by conditions such as cardiomyopathy, coronary artery disease, heart conditions present at birth, or pulmonary hypertension (high blood pressure in the lungs).

Conditions we treat with heart transplant

A heart transplant may be an option to treat severe heart disease, including:

• Advanced heart failure — When your heart can’t pump enough blood to support your body's needs.
• Arrhythmia — An irregular heartbeat which, if left uncontrolled or untreated, can cause the heart to wear out or worsen other heart conditions.
• Cardiomyopathy — When your heart muscle becomes diseased, enlarged, or rigid, and can’t pump blood effectively.
• Congenital heart disease — A heart defect that is present at birth.
• Coronary artery disease — A narrowing of the blood vessels that supply blood and nutrients to the heart.
• Heart valve disease — An illness characterized by one or more of your four heart valves not working properly.
• Pulmonary hypertension — High blood pressure in the lungs that can cause heart failure.

Why Would I Need a Heart Transplant?

You may need heart transplant surgery if you have severe, life-threatening heart disease that is no longer responding to medical treatment.

Who’s a candidate for a heart transplant?

You may be a candidate for a heart transplant if you:

• Are younger than 69 years old.
• Have been diagnosed with end-stage heart failure caused by a condition such as cardiomyopathy or coronary artery disease.
• Have been given a prognosis that suggests you have a risk of death within the next year if a heart transplant is not performed.

Heart failure causes and stages

Heart failure is caused by conditions that strain and weaken your heart muscle. As a result, your heart can't pump or fill with blood well enough to meet your body’s needs.

The most common causes of heart failure are:

• Coronary artery disease.
• Diabetes.
• High blood pressure.

Heart failure evolves in stages from:

• I to IV based on symptoms.
• A to D based on the signs your doctor sees in an exam.

People who are most qualified for a heart transplant tend to have between stage IIIB and stage IV heart disease. This means you experience symptoms and limitations when performing mild activity or even when resting.

Who is not a candidate for a heart transplant?

Although a heart transplant may be a lifesaving option, not everyone is a candidate for the operation.

You may not be a candidate for a heart transplant if you are unable to comply with treatment requirements before or after surgery, or have other serious conditions that could increase your risk of complications, including:

• Active infection.
• Alcohol or drug abuse.
• Cancer.
• Diabetes.
• Kidney or liver disease.
• Vascular disease.

Alternatives to heart transplant surgery

• Advanced medical therapy.
• Coronary artery bypass graft (CABG).
• Left ventricular assist device (LVAD).
• Total artificial heart.
• Valve repair or replacement.

What Are the Risks and Complications of a Heart Transplant?

All surgical procedures carry some risk, including reactions to anesthesia, breathing problems, bleeding, and infection.

However, heart transplant surgery comes with additional risks and may cause complications that include:

• Arrhythmias — Abnormal heart rhythms.
• Blood clots.
• Heart attack or stroke.
• Lung or kidney failure.
• Problems with your new heart.
• Rejection of your new heart.
• Side effects from post-surgical antirejection medications.

What Should I Expect from a Heart Transplant?

The first step in the transplant process is for your doctor to refer you to UPMC for heart transplant services. We also accept self-referrals.

After you are referred to our program, our heart transplant team will:

• Look at your medical records.
• Check your insurance benefits. A credit analyst will contact you to discuss your coverage and the costs of transplant surgery.
• Decide if you're a good candidate for a heart transplant evaluation.
• Get you started on your heart transplant journey.

We work closely with your referring doctor to learn about your heart problem and how a transplant might help you.

Your heart transplant journey

Our heart transplant team assesses every person referred to our program. Our transplant cardiologists, surgeons, and other team members work together to decide if you would benefit from a transplant.

Factors that help decide if a heart transplant is right for you include:

• Ability to stick to the treatment plan before and after transplant.
• Age.
• Height and weight, which can affect the waiting period and likelihood of receiving a transplant.
• Medical options to manage heart disease.
• Other diseases that may affect the outcome of transplant or increase the risks of surgery.
• Severity of your heart disease.

After your heart transplant, you'll need to take medicines that suppress your immune system for the rest of your life.

If the care team finds you might be a good fit for a heart transplant, your journey will begin.

The four stages of the heart transplant journey are:

Pre-heart transplant exams and tests

This stage of the process begins after insurance has approved the costs of the tests. You'll have a number of outpatient tests and consults to see if a heart transplant is right for you. These tests and consults take about a week to complete.

You must bring a care partner to all of your visits to UPMC.

The heart transplant exams and tests are physically demanding. It can be hard for someone with heart disease to get from one appointment, test, or location without help.

If we decide you're a good fit for transplant, we'll work with your insurance plan to approve the surgery.

How much does a heart transplant cost?

The cost of a heart transplant can vary from person to person, depending on many factors. Our team is here to make sure you can handle the burden, understand your insurance coverage, and help you find financial aid if you need it. Your UPMC heart transplant credit analyst and social worker will help you discern what parts of your care your insurance will cover.

Waitlist

Next, we'll add you to the heart transplant waiting list. Your cardiologist will manage your heart failure as you wait for a new heart.

You need to be able to get to UPMC within four hours after you're on the heart transplant waiting list. Many people drive, but some arrange private flights to Pittsburgh. Your social worker can give you details about flights.

How long will I need to wait for a new heart?

Heart transplant waiting list times are hard to predict and highly variable — from one day to over a year. Some factors that affect your wait time for a heart include your:

• Blood type.
• Health status.
• Size.

Before your heart transplant surgery

When a donor heart is ready, your transplant coordinator will call you to come to the hospital for your transplant. You'll receive special care throughout your stay. 

It's crucial that you get to the hospital right away. We ask people on the heart transplant waiting list to be within a four-hour travel time from UPMC.

Before coming to the hospital

Before coming to the hospital for your heart transplant:

• Do not eat or drink anything.
• Pack your phone and charger.
• Bring your medicines.
• If you have a ventricular assist device (VAD), bring your equipment.

When you arrive at the hospital

When you arrive at UPMC, we will prep you for your heart transplant surgery.

The donor team will inspect the heart to make sure it's suitable for transplant and a match for you.

In the meantime — to make sure you're in good health with no active illnesses — you'll:

• Complete a medical history and physical examination.
• Have blood work.
• Get x-rays.

Before moving you to the OR, your anesthesiologist will speak with you about what to expect. You'll receive general anesthesia and sleep through the heart transplant procedure.

You will also speak to one of the surgical team members to provide consent for the transplant to take place.

How long does heart transplant surgery take?

The amount of time for a heart transplant depends on the complexity of your case and whether you need other procedures.

If you do not have a VAD, surgery should take three to four hours.

If you have a VAD that needs to be removed, or you've had prior chest surgeries, it should take six to eight hours.

During your heart transplant surgery

During your heart transplant, your surgeon and care team will:

• Connect you to a heart-lung machine. It does the work of your heart and takes the strain off your lungs. It pumps filtered, oxygen-rich blood into your body, allowing your heart to rest during the operation.
• Remove your diseased heart.
• Replace it with the healthy donor heart.

After the donor heart is placed into your open chest, your surgeon will attach it to the surrounding major blood vessels. It should usually start beating after blood flow is restored; however, an electric shock can be used to initiate it if necessary.

Recovery after heart transplant surgery

Our team is here for you when you need us for the rest of your life.

After your heart transplant, you will:

• Start taking antirejection drugs right away. When your body detects something new, your immune system begins working to fight what it views as a threat. Antirejection drugs suppress your immune system's natural response, so your body will accept the new organ.
• Be in the Cardiothoracic ICU for about three days before moving to a room on the transplant floor.
• Stay in the hospital for about 10 to 14 days, but this varies based on how sick you are prior to your transplant.

During this time, the heart transplant team will:

• Adjust your medications to find the right mix.
• Create an eating plan for you to follow at home. A registered dietitian will develop your eating plan and review it with you.
• Teach you coughing and breathing exercises that you'll need to do often. These help keep your lungs clear and prevent pneumonia.
• Watch for rejection, infection, or other problems.
• Work with you and your care partner to prepare for managing your care at home.

Before you leave the hospital, make sure you and your caregiver clearly understand:

• Any other instructions for at-home care.
• The meal plan and nutrition guidelines.
• Your follow-up care schedule (blood work, clinic visits, and testing).
• Your medication schedule.

Please feel free to ask members of your UPMC heart transplant team to explain anything you're unsure of and answer any questions you may have. We're here for you through each stage of your transplant journey.

Follow-up care after discharge from the hospital

After heart transplant surgery, you begin the journey of healing and enjoying the gift of your new heart.

As you heal after heart transplant surgery, you'll need to:

• Have follow-up tests and attend all appointments.
• Move around and focus on regaining the strength and muscle mass that you lost while being sick before your transplant.
• Take care of your incision site.
• Take medicines twice a day.

You will need to stay close to UPMC for at least a month after your heart transplant. If you don't live nearby, you and your care partner can arrange for a room at Family House until you can go home. Family House offers patients and their loved ones an affordable home away from home.

Learn more about traveling to Pittsburgh for transplant services.

For the first four weeks, you'll come back once a week for biopsies. During the biopsies, we take a tiny piece of your heart muscle and look for signs of inflammation or rejection. This is the only way doctors can tell early on if your body is rejecting your donor heart.

Then, if your recovery is going well, your appointments will follow this schedule:

• Month two post-transplant — Every other week.
• Months three to six post-transplant — Once a month.
• Months seven through 12 post-transplant — Every other month.

Along with tests and follow-up visits, the transplant team will ask you to keep track of and report any changes in your:

• Blood pressure
• Temperature
• Pulse
• Weight

Call us right away if you have any major changes, such as signs of an infection or problem. You can reach us at 412-648-6202 or toll-free 844-548-4591.

Cardiac rehabilitation after heart transplant

For people who need more help after heart transplant surgery, we may suggest spending time in inpatient rehab before going home. Our cardiac rehab services can help you recover and get stronger after your heart transplant.

Rehab lasts anywhere from six to 12 weeks and will help you:

• Keep up with the breathing exercises you started while in the hospital.
• Strengthen your whole body.

Recovering at home after heart transplant 

When you return home, you will not be able to drive for about six weeks after heart transplant surgery.

You'll need a care partner with you 24 hours a day for the first few months post-transplant.

This can be one person or a team of people who are willing to help you with daily tasks such as:

• Keeping track of changes to your health or any strange behaviors. Call the heart transplant team right away if you notice any major changes or problems.
• Taking your meds on time.
• Driving you to and from appointments.
• Refilling prescriptions, shopping, and running other errands.

Life after heart transplant

Recovery after transplant can be a challenge. Achieving the best results from your new heart and maintaining a high quality of life requires a strong commitment.

You'll need to follow the medication and lifestyle guidelines you received before and after your heart transplant surgery.

Medications

There is a risk that your body could reject your new heart after heart transplant surgery. To help avoid rejection, you'll need to take antirejection medicine every day for the rest of your life. It's vital to your recovery that you don't forget to take these meds.

After a heart transplant:

• You'll take some medicines for the rest of your life. It's crucial that you always take these on time and at the right dose.
• Do not stop taking your medications or try to adjust them on your own.
• Contact your transplant coordinator if other doctors or care teams prescribe medications for you. They will review them for potential interactions with your antirejection drugs.

You'll also need bloodwork so that we can keep an eye on your antirejection medicine levels. Your care team may prescribe other medications to manage or prevent:

• High blood pressure or diabetes.
• High cholesterol or lipid levels.
• Infection.
• Pain.

Call your transplant coordinator or pharmacist if you have any questions.

Infection prevention

Antirejection drugs help prevent your immune system from rejecting your new heart. However, they can also reduce your body's ability to fight infections.

To prevent infection, be sure to practice good hygiene and ask any visitors to do so as well.

Tips to prevent infection include:

• Ask loved ones and friends to avoid visiting when they are sick.
• Avoid crowds during peak times for illnesses, such as flu season.
• Wash your hands often.

Heart-healthy diet and nutrition

The nutritionist on your heart transplant team will work with you to develop a personalized eating plan. Certain foods can affect your medicines.

Your medications can also affect your potassium, phosphorus, and magnesium levels. You'll need to be careful about eating foods high in these nutrients to keep them in the proper range.

Your meal plan will suggest foods for you based on your medications.

A heart-healthy diet means you should:

• Avoid salty snacks, canned soups, or premade meals that tend to be high in sodium (salt).
• Eat recommended fruits, veggies, and lean meats.
• Limit your intake of fat, sugar, and salt.

It's important that you follow these guidelines to recover faster and ensure your new heart functions properly. 

Exercises for the heart

You will need to move around regularly after your heart transplant.

Follow these tips to help you recover and prevent blood clots:

• Attend a cardiac rehab program.
• Start with short walks and build up as you're able.
• Take short naps when you need to, but don't lie around in bed for long periods during the day.

Even after you've returned to daily living, your heart transplant team is here for you for the rest of your life. We'll stay in contact with you in case you have any side effects, issues, or questions after your heart transplant.

What’s the survival rate after heart transplant surgery?

Nationally, the average survival rate for heart transplant patients one year after surgery is 85% to 90%. The three-year post-operative survival rate is around 75%.

Why Choose UPMC for Heart Transplant Surgery?

When you choose UPMC for heart transplant surgery, you will have access to:

• Advanced VAD care — Our experts have pioneered VAD technology for more than 40 years. Our surgeons implanted the second Jarvik Artificial Heart as a bridge to transplant in 1985. Additionally, UPMC was the first medical center to discharge a patient with a VAD in 1990. Since then, we have implanted more than 1,300 VADs.
• Best-in-class outcomes — The Scientific Registry of Transplant Recipients (SRTR) reports UPMC as a national leader in 90-day survival rate. It is among the top nationally for survival rates at 30 days and one year post-transplant.
• Experienced, board-certified surgeons — With a rich history that includes more than 1,700 transplants over more than 40 years, the UPMC Heart Transplant Program is among the most experienced programs in the world.
• Multidisciplinary, groundbreaking care — For patients requiring multiple organ transplants, the UPMC Heart Transplant team collaborates with experts across UPMC Transplant Services to perform heart-lung, heart-liver, and heart-kidney transplants. UPMC performed the world’s first heart-liver transplant in 1984, and the world’s first heart-liver-kidney transplant in 1989. UPMC also performed the nation’s first beating heart transplant.
• Second-opinion services for high-risk cases — UPMC experts offer second-opinion services even for those who have been deemed high risk and were turned down for a transplant at another center.
• Bloodless heart transplants — We perform heart transplants for adult patients who need a transplant but cannot or choose not to receive blood components, including plasma, platelets, red blood cells, and white blood cells. From transplant evaluation to post-transplant care, our team is here to support patients every step of the way.

Learn More From UPMC HealthBeat

• The Heart Transplant Process at UPMC.
• Expanded Treatment Options for Heart Transplant Patients at UPMC.

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By UPMC Editorial Staff. Last reviewed on 2025-12-09.