Heart Failure and Transplant

The Methodist Heart and Lung Institute has provided patients with an information and educational resource page to aid in the heart failure and transplant journey. Please review the glossary and list of frequently asked questions.

ACE (angiotensin converting enzyme) inhibitors - A type of heart failure medication that works by preventing the body from creating angiotensin, a substance in the blood that causes vessels to tighten and raises blood pressure. In large-scale studies, ACE inhibitors have been proven to slow the progression of heart failure.

Advance Directive - A written document that states a person's healthcare choices and names someone to make those choices, should the person become unable to make their own decisions about medical care. The most common types of Advance Directives are a living will and a durable power of attorney for healthcare.

Anemia - A reduction in the amount of oxygen-carrying red blood cells. Anemia can have many causes, but the most common is a lack of iron in the body. Also known as iron-poor blood.

Angiography - An X-ray test used to detect diseases of the blood vessels, such as weakening of the vessel walls and the narrowing or blocking of vessels. The X-ray is taken after the vessels have been injected with a substance that allows them to be seen on film.

Angioplasty - A procedure that reopens blocked blood vessels to the heart. A physician inserts a hollow needle (catheter) into the diseased artery and pushes a small deflated balloon into the blocked section. Then the physician inflates the balloon to widen the artery.

Angiotensin II receptor blocker - A medication that blocks the action of a special chemical called angiotensin, which normally raises the heart rate and blood pressure.

Arrhythmia - An abnormal rhythm or rate of the heartbeat caused by disturbances in the movement of electrical impulses through the heart.

Atrial fibrillation - Rapid, uneven contractions in the upper heart chambers (atria), which cause the lower chambers (ventricles) to beat irregularly.

Atrium - One of the two upper chambers of the heart.

Beta blockers - Medications that reduce the heart's tendency to beat faster by blocking specific receptors ("beta receptors") on the cells that make up the heart.

Blood thinners - Medications, such as warfarin and heparin, used to prevent blood clotting. Some people with heart failure are prescribed blood thinners to reduce the risk of stroke.

Calcium channel blocker - A drug that prevents calcium from entering the heart's muscle cells. This causes the muscles to relax, lowering the heart rate.

Cardiac rehabilitation - A supervised program of increasing exercise, mental support and training to allow a person with a heart condition to resume normal activities.

Cardiologist - A doctor who diagnoses and treats heart problems.

Cardiomyopathy - Any weakening or deformity of the heart muscle that causes decreased pumping force. This leads to less-efficient circulation of blood through the lungs and the rest of the body.

Cardiomyoplasty - An investigational surgical treatment for heart failure that involves taking muscles from the person's back or abdomen and wrapping them around the heart. Its goal is to increase the heart's pumping power.

Caregiver - Anyone who helps a chronically ill patient cope with an illness. Caregivers can be home healthcare workers, family members or friends. They assist in many ways, from making sure patients take their medications properly to helping out with day-to-day activities.

Chronic illness - An illness or condition that develops slowly and persists for a long time. Heart failure is almost always a chronic illness.

Congenital heart disease - Any heart condition or abnormality that a person was born with.

Congestive heart failure - A common form of heart failure that results in a patient retaining excessive fluid, often leading to swelling of the legs and ankles and congestion in the lungs.

Coronary artery bypass - A procedure used to reroute the blood supply around a blocked section of a coronary artery. Surgeons remove healthy blood vessels from another part of the body, such as a leg or the chest wall. Then they surgically attach the vessels to the diseased artery to let the blood flow around the blocked section.

Coronary artery disease - A condition caused by thickening of the walls of the arteries that supply blood to the heart muscle. When these arteries become blocked, the heart is deprived of oxygen and can become damaged. Severe cases can result in heart attack.

Defibrillator - A device that delivers pacing or an electric counter shock to the heart when an abnormal rhythm is detected. A surgically implantable version is called a pacemaker.

Diabetes - A condition in which the body doesn't produce the right amount of insulin, the hormone that allows cells to absorb glucose (sugar) from the bloodstream. Some people with diabetes must inject themselves with insulin every day to maintain a healthy glucose level. Others are able to control the condition with pills or a special diet.

Diastolic pressure - The pressure of blood inside arteries when the heart is at rest. This is the bottom number in a blood pressure reading.

Digoxin (or digitalis) - A medication that increases the force of the heart's contractions and slows certain types of irregular heartbeats (arrhythmia).

Diuretic - A medication that promotes the formation and release of urine. It helps to reduce fluid overload in people with heart failure. Also called a water pill.

Drug interaction - A change in the effect of a drug when taken with a certain other drug or food. Its effect may increase or decrease, or a side effect may occur.

Dyspnea - Difficult or labored breathing, often caused by heart conditions.

Dysrhythmia - A disturbance in heart rhythm, sometimes used as an alternative to the term "arrhythmia."

Echocardiography - A test that obtains an image of the structure and motion of the heart using ultrasound (inaudible, high-frequency sound waves). Used to detect cardiomyopathy and other abnormalities of the heart wall, valves and large blood vessels.

Edema - An abnormal accumulation of fluid in body tissues. Edema is common in the legs, ankles and lungs of people with heart failure.

Ejection fraction - The amount of blood released during each contraction of the lower ventricle of the heart. It's usually expressed as a percentage: an ejection fraction of 60 percent means that 60 percent of the total amount of blood in the left ventricle is expelled with each heartbeat.

Electrocardiogram (EKG or ECG) - A record of the electrical activity of the heart, allowing diagnosis of abnormal heart conditions.

Endocarditis - Inflammation of the lining of the heart and the heart valves, usually due to bacterial infection.

Heart attack - Sudden death of a portion of the heart muscle caused by a sudden decrease in blood supply to that area. Also known as myocardial infarction or MI.

Heart disease, ischemic - The most prevalent form of heart disease, in which narrowed or blocked coronary arteries result in decreased blood supply.

Heart failure - The inability of the heart to keep up with its workload. When someone has this condition, their heart can't pump enough blood to the lungs and the rest of the body. Heart failure is often a chronic condition that can be treated with medications, diet and other lifestyle changes, and in some cases, surgery.

Heart transplant - Surgery that replaces a damaged heart with a healthy heart taken from a donor who has been declared brain dead.

Heart valve - One of the four structures in the heart that control the flow of blood by opening and closing with each heartbeat. The valves permit blood to flow in only one direction.

Hypertension - The medical term for abnormally high blood pressure.

Hyperthyroidism - Over activity of the thyroid gland, leading to overproduction of thyroid hormones. It can make the body's metabolism overactive, leading to symptoms such as weight loss and rapid heart rate.

Hypotension - Abnormally low blood pressure.

Left-ventricular assist device - A mechanical pump used to aid the natural pumping action of the heart's left ventricle.

Left-ventricular heart failure - Heart failure in which the left side of the heart must work harder to pump the same amount of blood. This type of heart failure usually causes breathing difficulties.

MUGA (Multigated Acquisition) - A test in which a radioactive tracer is injected into the bloodstream and scanned as it passes through the heart. A computer then calculates the size and shape of a patient's ventricles based on the amount and distribution of radiation they emit.

Myocardial infarction - Sudden death of a portion of the heart muscle caused by a sudden decrease in blood supply to that area. (see Heart attack)

Myocarditis - Inflammation of the heart muscle.

Potassium - A mineral that, together with sodium and calcium, regulates the body's water balance, maintains normal heart rhythm, and is responsible for nerve impulse conduction and muscle contraction.

Primary care doctor - A general internist or family physician who provides patients with routine preventive healthcare and is their first contact when medical problems arise.

Pulmonary edema - Fluid in lung tissues, often caused by congestive heart failure.

Right-ventricular heart failure - Heart failure caused by damage to the right-side chambers of the heart, leading to decreased blood flow, and swelling in the hands, legs and abdomen.

Side effect - Any reaction that results from a medication or therapy. Heart failure medications can cause side effects such as headaches, nausea, dizziness, kidney complications and low blood pressure.

Sodium - A mineral that, together with potassium and calcium, regulates the body's water balance, maintains normal heart rhythm, and is responsible for nerve impulse conduction and muscle contraction. Excessive intake of sodium from food contributes to high blood pressure in some people. In people who already have high blood pressure, too much sodium may increase the risk of stroke, heart disease and kidney damage.

Stress test - An exercise test that examines how well the heart works. Patients are asked to walk on a treadmill to increase their heart rate. During the test, a doctor monitors electrocardiogram (ECG or EKG) readings from the heart to check for any heart rhythm irregularities.

Systolic pressure - The pressure of blood inside arteries when the heart contracts. This is the top number in a blood pressure reading.

Vaccine - Weakened or dead germs, given by injection, that protect against infectious disease. People with heart failure should receive a yearly influenza vaccine and a one-time pneumococcal vaccine (to guard against pneumonia).

Valve replacement - Surgery to replace a defective or diseased heart valve.

Vasoconstriction - A narrowing of a blood vessel, causing decreased blood flow to a part of the body.

Vasodilator - A medication that causes widening or relaxation of blood vessel walls. Examples include ACE inhibitors, angiotensin II receptor blockers, beta blockers, calcium channel blockers, natriuretic peptides and nitrates.

Ventricle - One of the two lower chambers of the heart that receive blood from the atria (upper chambers). The right ventricle pumps blood to the lungs and the left ventricle pumps blood to the rest of the body.

What is transplantation?

Transplantation is the act of surgically removing an organ from one person and placing it into another person. Transplantation becomes necessary when the recipient's organ has failed or has been damaged through illness or injury.

Which organs can be transplanted?

  • Liver
  • Kidney
  • Pancreas
  • Kidney/Pancreas (can be transplanted at the same time)
  • Heart
  • Lung
  • Heart/Lung (can be transplanted at the same time)
  • Intestine

What questions should I ask about the cost of transplantation?

  • What part of the transplant cost is covered by my insurance?
  • How much will I have to pay?
  • What happens if my financial coverage runs out?
  • Who are the members of the transplant team and what are their jobs?
  • Who will tell me about the transplant process?
  • Is there a special nursing unit for transplant patients?
  • Can I tour the transplant center?
  • Will I be asked to take part in research studies?
  • Does the hospital do living donor transplants?
  • If a living donor transplant is a choice in my case, where will the living donor evaluation be done?

Do transplant hospitals in the U.S. only perform transplants on U.S. citizens?

No. Patients from other countries may travel here to receive transplants. Once accepted by a UNOS transplant center, international patients receive organs based on the same policies as U.S. citizens.

What factors are considered in organ matching and allocation?

Many different medical and logistical characteristics are considered for an organ to be distributed to the best-matched potential recipient. While the specific criteria differ for various organs, matching criteria generally include:

  • Blood type and size of the organ(s) needed
  • Time spent awaiting a transplant
  • The distance between donor and recipient

For certain organs other factors are vital, including:

  • The medical urgency of the recipient
  • The degree of immune-system match between donor and recipient
  • Whether the recipient is a child or an adult

How does the matching process work?

  • An organ is donated. When the organ becomes available, the Organ Procurement Organization (OPO) managing the donor sends information to the (United Network for Organ Sharing (UNOS). The OPO procurement team reports medical and genetic information, including organ size, and condition, blood type and tissue type.
  • UNOS generates a list of potential recipients. The UNOS computer generates a list of potential transplant candidates who have medical and biologic profiles compatible with the donor. The computer ranks candidates by this biologic information, as well as clinical characteristics and time spent on the waiting list.
  • The Transplant Center is notified of an available organ. Organ placement specialists at the OPO or the UNOS Organ Center contact the centers whose patients appear on the local list.
  • The Transplant Team considers the organ for the patient. When the team is offered an organ, it bases its acceptance or refusal of the organ upon established medical criteria, organ condition, candidate condition, patient availability, and organ transportation. By policy, the transplant team has only one hour to make its decision.
  • The organ is accepted or declined. If the organ is not accepted, the OPO continues to offer it for patients at other centers until it is placed.

How do I get on the waiting list?

To get on the national waiting list, the following must take place:

  • Receive a referral for transplant evaluation from your physician.
  • Contact a transplant hospital.
  • Schedule an appointment for evaluation to determine if you are a good candidate for transplant.
  • During the evaluation, ask questions to learn as much as possible about that hospital and its transplant team.
  • The hospital's transplant team will decide whether you are a good transplant candidate. If after evaluation, the transplant team determines that you are a good transplant candidate, they will add you to the national waiting list.

How long will I have to wait?

There is no set amount of time, and there is no way to know how long, a patient must wait to receive a donor organ. Factors that affect waiting times are patient medical status, and the level of match between the donor and recipient.

How are organs distributed?

The organs are distributed locally first, and if no match is found they are then offered regionally, and then nationally, until a recipient is found. Every attempt is made to place donor organs.