Transplantation is a surgical procedure in which a failing organ or tissue is replaced with a healthy one from a donor, either a living donor or a deceased donor. In cardiovascular medicine, the most important form is heart transplantation.
Heart transplantation is the definitive treatment for end-stage heart failure that cannot be managed with medical therapy, cardiac resynchronisation therapy, or mechanical circulatory support. The recipient’s failing heart is removed and replaced with the donor’s healthy heart. The operation requires cardiopulmonary bypass and is performed at specialist transplant centres. The number of heart transplants is limited by donor organ availability.
After heart transplantation, recipients must take immunosuppressant medications for life to prevent rejection. Regular surveillance with echocardiography and endomyocardial biopsies is performed to detect and manage rejection. The median survival after heart transplantation is now approximately 12 to 13 years, with many patients surviving 20 years or more. Cardiac allograft vasculopathy (progressive coronary artery disease in the transplanted heart driven by immunological processes) is the main long-term complication.
Transplantation is relevant to cardiac arrest in two ways: patients with end-stage heart disease who are awaiting transplantation may be at elevated cardiac arrest risk, and cardiac arrest survivors with severe irreversible cardiomyopathy may ultimately be assessed for transplantation if medical and device therapies are insufficient to maintain quality of life.
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