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​​​​​​​​​​​​​​​​​​​​​​​​Overview of Heart Transplant Program

Baylor Scott & White Health has treated some of the most complex heart transplant cases and helped patients who have been turned away by other medical centers. Baylor University Medical Center at Dallas and Scott & White Medical Center - Temple are the only two Baylor Scott & White Health's locations in the state of Texas that offer heart transplants.​

Dual Listing for​ Heart Transplant 

We understand that waiting for a donor organ can be stressful. According to the United Network of Organ Sharing (UNOS), nearly  50 percent of those on the waiting list must wait more than five years from their listing date to receive a transplant.

At Baylor Scott & White, we know advanced heart failure is debilitating and the ability to receive a transplant as soon as possible after diagnostic confirmation is optimal, since it can make a difference in the patient’s outcome and quality of life. ​

Non-Transplant Treatment Options

We offer advanced treatment options for patients who are not candidates for transplant or who are on a heart transplant list long-term. A VAD​ is a mechanical device used to take over the pumping function for one or both of the heart's ventricles, or pumping chambers. A VAD may be needed when heart failure progresses to the point that medicines and other treatments are no longer effective. A VAD can be used as a bridge to transplant for a person who is waiting for a heart transplant.​

Our Team of Heart Transplant Specialists

The team of heart transplant specialists include transplant cardiologists and surgeons on the medical staff, certified heart failure nurses, transplant coordinators, dietitians, social workers and more.​

Our team of cardiac specialists aggressively pursues ways to save lives, with a remarkable median wait time of seven days for status 1A heart transplant patients from the time they are listed to the transplant.

Heart Transplant Process

At Baylor Scott & White, we're here with you every step of the way during the heart transplant process. Find out more about what to expect.

Heart Transplant Process – Evaluation

The transplant evaluation starts with a comprehensive review of your past medical history by a transplant cardiologist. You'll meet with the transplant cardiologist to discuss the nature and prognosis of your cardiac disease and determine if any other traditional treatments would be beneficial prior to consideration of a cardiac transplant. Certain cardiac tests may need to be performed that are different from prior tests you may have had with your cardiologist. The next step involves determining if your body is well enough to achieve a successful outcome from a cardiac transplant. This also involves a lot of testing and consultations. A team of specialists including physicians, nurses, social workers and transplant coordinators will meet to review your case and determine your best course of care and potential for listing.

Heart Transplant Criteria

One criterion for being on the transplant list is the ability to get to our facility within four hours. You can accomplish this by simply driving, arranging after-hours air flight capability or temporarily moving closer to the transplant hospital.

After the transplant, you must live within 30 miles of the transplant hospital for the first 6-8 weeks. Baylor Dallas and Scott & White – Temple have a low-cost on-campus apartment, Twice Blessed House, where patients and their families may live during this time.

How Long Will I Wait for a New Heart on the Heart Transplant List?

Unfortunately there is no way to predict how long it will take. Several factors including blood type, body size, severity of illness and presence of antibodies all play a part in the waiting time. Baylor Dallas has one of the shortest wait times in the country and is currently a median of seven days. A 1A status is eight days wait time and status 1B is less than two weeks. Median wait times vary by transplant center.

What Happens During a Heart Transplant Surgery?

No matter how well prepared you feel, it is often still a shock to get the call that a suitable donor has been identified and matched to you. You will be instructed as to when to get to the hospital, often as quickly as possible, which is why there are distance limitations of how far away from the transplant center you may live. Simply have a to-go bag ready with simple necessities (sort of like preparing for the birth of a baby) and get to the center as directed.

Upon arrival there will be a flurry of activity - an IV will be placed, blood work drawn, X-ray taken, paperwork to fill out, visitation by several medical personnel, etc. Often the initial time given to you changes since several transplant teams for each organ from the donor have to be coordinated to arrive at the same time. Simply take a deep breath, relax and try not to worry.

Life After a Heart Transplant Operation

After the heart transplant surgery, the usual time in the ICU is one to three days and then four to 10 days on the transplant floor. The sicker and weaker you are going into to the surgery, the longer it will take to recover after the surgery, and some patients require a rehab facility afterwards for further strengthening. During this time you will be closely monitored and educated as to the new medications and possible issues you may be facing after the transplant. You will receive a post heart transplant manual after your surgery.

Medications

Immediately after your heart transplant operation, you'll be started on special medications to maximize the survival benefit of the transplant. These are on top of the other medicines you have been taking for your non-cardiac conditions. Over the first year, your transplant team may adjust several of the medicines. You'll be weaned down or off some, and others may be increased.

  • Immunosuppressants – These medications are to help prevent a heart transplant rejection by suppressing your body's natural immune responses.  
  • Antibiotics, antivirals, antifungals – These medications are to assist in preventing infections that you are more prone to since your immune system is weakened. 
  • Vitamins, minerals - These medications help the body in the healing process and maintaining good health. 
  • Cholesterol medications – These medications help prevent the development of coronary artery disease in your new heart. 
  • Blood pressure medications – Most transplant recipients develop hypertension and thus require blood pressure medicines. 

Ongoing Treatment

After your discharge, you will be closely monitored by the entire transplant team, which includes the transplant cardiologist, advanced care practice nurses and coordinators. You will be given a specific schedule of visits, which will include blood work, chest X-rays, clinic exams and heart biopsies. The transplant team will send updates to your referring cardiologist and primary care physician. All of your medical care the first year will be under the transplant team. After the first year, all of your primary care will be returned to your primary care physician and you will see the transplant team less frequently. However, you will see the transplant team for your entire life with biannual checkups to monitor for any complications associated with life-long immunosuppression or heart transplant rejection.

Common Problems After Transplant

Medication side effects – There is a long list of potential side effects from all of the medicines. The most common include tremors, insomnia, nausea and high blood pressure.

Heart Transplant Rejection – This occurs when your immune system reacts to your heart and tries to damage it. We are in constant surveillance of this problem with biopsies and specialized blood tests, so that most of the time, we find early rejection before symptoms develop or damage occurs. This is why staying with your follow-up schedule is so important. If a rejection is detected, your oral immunosuppression meds may be adjusted or you may receive IV steroids. This is most likely to occur in the first year.

Infections – Because your immune system is suppressed, infections are a real risk. Some medications are given to prevent infections. Other times, we watch for early signs of infection and treat at that time. The greatest danger for this is the early months after your heart transplant surgery when your immune suppression meds are at their highest doses.

Returning to Work

The appropriate time to return to work depends on several factors - how ill you were prior to your heart transplant surgery, how long it takes you to recover after the surgery and what type of work you are doing. Once your incisions heal and you are feeling well, you will discuss this timing with your transplant team. Some are able to return to work in a matter of weeks, others could be months. Your team wants you to return to work as soon as it is safe to do so. If you were on cardiac disability at the time of your heart transplant operation, this will remain in effect until one year after the transplant. After the one year, cardiac disability is no longer in effect and you could lose those benefits.

Will Insurance Cover the Cost of a Heart Transplant?

We have a financial coordinator who will help you and your family with financial related questions or concerns regarding your transplant coverage.

The Heart Transplant Waiting List Process

Each transplant center is located within a specific region served by a specific organ bank and a specific recipient list. Organs are offered first by the organ bank to the facilities within its own region based on status level and time on the list. If a match is not found within the organ bank region, then the donor organ may be offered outside the region to other centers to their sickest patients prior to returning to the region for less sick patients. 

There are four status levels for the heart transplant waiting list. Patients can move from one status to another based on the clinical situation. 

Status 1A is the highest priority status and is composed of patients who are critically ill, often living in an ICU on multiple IV infusions or temporary mechanical support devices or patients who are living with an LVAD which is having a complication. Organs are first offered to this status in a region. 

Status 1B is the next priority and is for patients in the hospital or living at home on a continuous IV infusion of an inotrope (dobutamine, milrinone) or an LVAD.   

Status 2 is the lowest active priority and is for patients with advanced heart disease who do not qualify for status 1A or 1B. Hearts would be offered to these patients if there were no 1A or 1B patients who would be suitable and thus often have the longest wait time but are also the least ill. 

Status 7 is inactive and thus would not be offered a heart. This can occur if a patient gets too ill or too well for transplant or has traveled away from the transplant center for a time and thus could not come in for a transplant. 

Once on the heart transplant waiting list, you will be followed regularly by the transplant team and medical adjustments are often made. Sometimes hospitalization may be required and moving up to a higher status can occur. If you become too sick for a transplant, your status would be changed to 7 and efforts will be made to improve your condition to the point of medical stability.

How are donor hearts matched?

Each transplant center is located within a specific region served by a specific organ bank and a specific recipient list. Organs are offered first by the organ bank to the facilities within its own region based on severity of illness and time on the list. Other factors such as blood type, body size and presence of antibodies also play a role. If a match is not found within the organ bank region, then the donor organ may be offered outside the region to other centers to their sickest patients prior to returning to the region for less sick patients.

What happens if I get sicker while I am on the waiting list?

Once on a transplant list, you will be followed regularly by the transplant team and medical adjustments are often made. Sometimes hospitalization may be required and moving up to a higher status can occur. Sometimes you can become too sick for transplant and you would be inactivated (status 7) and efforts to improve your condition to the point of medical stability would be attempted.

What happens when I get called for the transplant?

No matter how well prepared you feel, it is often still a shock to get the call. You will be notified that a suitable donor has been identified and matched to you. You will be instructed as to when to get to the hospital, often as quickly as possible, which is why there are distance limitations of how far away from the transplant center you may live. Simply have a to-go bag ready with simple necessities (sort of like preparing for the birth of a baby) and get to the center as directed. Upon arrival there will be a flurry of activity - an IV will be placed, blood work drawn, X-ray taken, paperwork to fill out, visitation by several medical personnel, etc. Often the initial time given to you changes since several transplant teams for each organ have to be coordinated to arrive at the same time to the donor. Simply take a deep breath, relax and try not to worry.

How long will I be in the hospital after my transplant?

After the surgery, the usual time in the ICU is one to three days and then four to 10 days in the transplant floor. The sicker and weaker you are going into to the surgery, the longer it will take to recover after the surgery. Some patients require a rehab facility afterwards for further strengthening. During this time you will be closely monitored, educated as to the new medications and possible issues you may be facing after the transplant. You will be started on special medications (see below). You can download the manual that you will receive after the transplant from this website.

What are the different medications for?

Heart transplant recipients take many medications to maximize the survival benefit of the transplant. Immediately after the transplant most of the medications are started on top of your other medicines you have been taking for your non-cardiac conditions. Over the first year, several of the medicines will be adjusted by your transplant team. Some will be weaned down or off and some may be increased.

  • Immunosuppressants - These medications are to help prevent rejection of the heart by suppression your body's natural immune responses.
  • Antibiotics, antivirals, antifungals - These medications are to assist in preventing infections that you are more prone to since your immune system is weakened.
  • Vitamins, minerals - These medications help the body in the healing process and maintaining good health.
  • Cholesterol medications - These medications help prevent the development of coronary artery disease in your new heart.
  • Blood pressure medications - Most transplant recipients develop hypertension and thus require blood pressure medicines.

Who will take care of my health needs after I leave the hospital?

After your discharge, you will be closely monitored by the entire transplant team, which includes the transplant cardiologist, advanced care practice nurses and coordinators. You will be given a specific schedule of visits, which will include blood work, chest X-rays, clinic exams and heart biopsies. The transplant team will send updates to your referring cardiologist and primary care physician. All of your medical care the first year will be under the transplant team. After the first year, all of your primary care will be returned to your primary care physician and you will see the transplant team less frequently. However, you will see the transplant team for your entire life with biannual checkups to monitor for any complications associated with life-long immunosuppression or rejection of the heart.

What are the common problems after transplant?

Medication side effects – There is a long list of potential side effects from all of the medicines. The most common include tremors, insomnia, nausea and high blood pressure.

Rejection – This occurs when your immune system reacts to your heart and tries to damage it. We are in constant surveillance of this problem with biopsies and specialized blood tests, so that most of the time, we find early rejection before symptoms develop or damage occurs. This is why staying with your follow-up schedule is so important. If a rejection is detected, your oral immunosuppression meds may be adjusted or you may receive IV steroids. This is most likely to occur in the first year.

Infections – Because your immune system is suppressed, infections are a real risk. Some medications are given to prevent infections. Other times, we watch for early signs of infection and treat at that time. The greatest danger for this is the early months after transplant when your immune suppression meds are at their highest doses.

How soon can I return to work?

The appropriate time to return to work depends on several factors - how ill you were prior to surgery, how long it takes you to recover after the surgery and what type of work you are doing. Once your incisions heal and you are feeling well, you will discuss this timing with your transplant team. Some are able to return to work in a matter of weeks, others could be months. Your team wants you to return to work as soon as it is safe to do so. If you were on cardiac disability at the time of your transplant, this will remain in effect until one year after the transplant. After the one year, cardiac disability is no longer in effect and you could lose those benefits.

What happens if I live far away from Dallas?

A criteria for listing for transplant is the ability to get to our facility within four hours. This can be accomplished by simple driving, arranging after hours air flight capability or temporarily moving closer to Dallas. At Baylor, our mean wait time for transplant is so short, most patients won’t have an extended wait. After transplant, you must live within 30 miles of Dallas for the first 6-8 weeks. Baylor has a low-cost on campus apartment, Twice Blessed House, where patients and their families may live during this time.

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