About the Program
The Heart Transplant Program in the Massachusetts General Hospital Transplant Center comprises leading heart experts from the Mass General Corrigan Minehan Heart Center to draw on state-of-the-art technology, leading medical and surgical interventions, and more than two decades of experience to provide patients with individualized care before and after their heart transplant.
Our Heart Transplant Program has been recognized for innovation and excellence since completing our first heart transplant in 1985. Our multidisciplinary team includes leading cardiologists and surgeons who provide comprehensive treatment to patients who require transplantation due to a variety of complex conditions, including:
- Cardiac amyloidosis: A condition in which abnormal protein builds up in the heart. Mass General is one of only seven hospitals in the United States performing cardiac amyloid transplants
- Cardiomyopathy: Any disease of the heart muscle in which the heart loses its ability to pump blood effectively
- Chronic heart conditions that do not respond to other therapies
- Heart failure: Also known as congestive heart failure, this condition occurs when the heart cannot pump enough oxygenated blood to meet the other organs’ needs
We are also a destination for patients who require multiple organ transplants and advanced care options, including stem cell transplantation.
Coordinated Patient Care and Support
As a patient in the Heart Transplant Program, your care begins with a comprehensive evaluation to determine if transplantation is your best treatment option. A transplant coordinator will help you through the evaluation process, gathering any necessary medical information and coordinating any needed tests or appointments, including a patient orientation.
After evaluation, eligible heart transplant patients are placed on the national United Network of Organ Sharing (UNOS) waiting list, which manages the distribution of organs nationwide. In the New England region, the waiting list is managed by the New England Organ Bank.
Your Heart Transplant Program care team will work with you and your physician to address health care issues that might develop as you wait for your transplant. Treatment options such as mechanical circulatory devices may be recommended as a bridge to transplantation.
Step 1: Your Evaluation
Your Mass General Heart Transplant care team guides you through the process of heart transplantation, including evaluation and pre-transplant care options.
Heart transplantation is reserved for patients who have no alternative treatment options and who are likely to respond well to transplantation. The transplant evaluation process is designed to determine whether you are likely to have a good outcome after your transplant.
Your evaluation will involve multiple tests that may include:
- Advanced imaging studies
- Blood tests
- Heart catheterization, which involves inserting a thin, flexible tube into the right or left side of the heart to diagnose some heart diseases
Your care team will work with you to coordinate your evaluation process. We recommend that you bring a family member or friend to each of your appointments to provide support and help collect information about your care.
Step 2: Joining the Heart Transplant Waiting List
If you are found to be a good candidate, you will be placed on a waiting list managed by the United Network for Organ Sharing (UNOS). UNOS is contracted by the federal government to manage the nation's organ transplant system.
UNOS has designed a system to allocate donor organs to potential recipients. Priority is given to the most severely ill patients when matching a donor heart to a waiting patient. This usually means that patients who are hospitalized and require continuous medical therapy to stay alive, and patients with mechanical circulatory support devices that have developed complications affecting device function, are given first access to donor organs.
While You're Waiting
There are occasions when a patient waiting at home, either without a mechanical support device or with a normally functioning device, will be matched with a donor organ. It is very important that all patients awaiting a donor heart be ready and available should the coordinator or physician contact you to come to Mass General for transplantation. Following the guidelines below is important as you await a donor organ:
- Maintain your health: Be sure to follow your medical regimen and the lifestyle changes your physician team has advised as you await transplantation. Should any evidence of deterioration in your health develop, please contact your transplant coordinator or physician so that this can be addressed prior to being called for a transplant. These symptoms include:
- Worsening shortness of breath
- Leg or ankle swelling
- An infection
- A hospitalization at another facility
- Be available and reachable: When a donor organ is available, you will receive a call from your coordinator or surgeon asking you to come to Mass General for the transplant. Since this call can come at any time during the day or night, any day of the week, it is important for the transplant team to be able to reach you. You should provide our center with all of your phone numbers, as well as the phone numbers of a few emergency contacts, so that we can contact you when needed
- Have accessible transportation to Mass General: Transportation can be particularly difficult during inclement weather. Please contact the transplant coordinator if you think that you will have difficulty getting to Mass General within four hours at any time while you are awaiting a donor heart
The time that patients spend waiting for a donor heart can be challenging. Do not hesitate to contact your transplant team should you have any questions or concerns during this period. Our transplant cardiologists, coordinators, social worker and psychiatrist will support you throughout the entire transplantation process.
Step 3: Pre-Transplant Care
Your care team will work with you and your local physician to address health care issues that may develop as you wait for your transplant. We offer:
- Medications to improve the heart’s function before transplant: We are recognized as world leaders in the development of inhaled nitric oxide and type 5 phosphodiesterase inhibitors to improve the function of the right side of the heart (right ventricle) in pre-transplant patients
- Ventricular assist devices (VADs) to improve patients’ quality of life and functional status before surgery: We were involved in the original research trials of several devices that were granted FDA approval, including HeartMate® Left Ventricular Assist Device (LVAD). We were also part of a multi-institutional study that first showed the positive impact of the continuous flow HeartMate II®. We offer several types of LVAD devices based on individual need
- Minimally invasive implantation procedures: We strive to minimize the number of invasive procedures our patients receive. Our cardiac surgeons are national leaders in minimally invasive implantation procedures for VADs
- Novel research studies: We offer many clinical trials for patients with advanced heart failure including drug trials, stem cell therapy and implantable devices to manage symptoms of heart failure. Learn more about our clinical trials and research program
- Supportive care: Illness and recovery are stressful, and emotional health is an important component of pre-transplant care. Our award-winning cardiac transplant psychiatrist specializes in working with patients to help mitigate the particular stresses facing transplant candidates and their families
Our commitment to your well-being extends to your postoperative care. We will help you arrange for stays at intermediate care facilities, or implement home services, following discharge.
Step 4: Post-Transplant Care
Once you receive your heart transplant at the Massachusetts General Hospital Transplant Center, our team will provide your follow-up care. At the time of your discharge, you will receive extensive instructions for all of your new medications and steps to take to ensure a healthy heart. You should follow your care team’s recommendations on diet, exercise and lifestyle changes. It is important to be your own advocate when you have concerns or questions.
Following transplantation, you will be taking immunosuppression medications daily to prevent your body from rejecting the heart. These drugs reduce your immune system function, so it is equally important to make sure you do not develop any infections after transplant.
Initially, you will be seen once a week in clinic, and you will have cardiac biopsies performed during many of these visits. A cardiac biopsy, also known as heart biopsy, is a procedure in which a small catheter is used to obtain a small piece of heart muscle tissue in order to detect heart disease. Chest X-rays and echocardiograms may be performed at some of these visits. These procedures help us monitor the function of your new heart and guide changes that we will make in your medications. One month after your surgery, these visits may occur every other week for the next two months and less frequently thereafter.
If a biopsy or other test indicates organ rejection, please be reassured that this is very common and does not mean that your new heart will fail. A change or temporary increase in your immunosuppression medication may resolve the rejection.
If for some reason you are unable to take your medications, unable to come to clinic or unable to have your blood drawn, please notify our team immediately so that we may assist you. We have a team on-call 24 hours a day, seven days a week to answer any questions.
In case of an emergency, please proceed to the nearest emergency room and have the doctor there call the Mass General Transplant Center at 617-724-1400. During evenings, nights and weekends, the transplant cardiologist on-call can be reached at 617-726-9292.
General Wellness Tips
- Avoid contact with sick people after surgery
- If someone is sick in your household, wear a surgical mask
- Wash your hands frequently
- Avoid driving until you are off all pain medications and able to move about without any discomfort
- Take walks daily
- Return to work when you feel comfortable
- Avoid heavy lifting for two months following surgery
Advancing Heart Failure Therapies and Transplantation
The Mass General Heart Transplant Program is a regional research center with an active clinical trials program. Researchers in the Heart Transplant Program are involved in a wide variety of clinical trials of new pharmacological agents for the management of heart failure and heart transplantation.
We provide patients and referring physicians with an experienced access coordinator, a clinician who helps assess patient needs, coordinate appointments and begin the appropriate testing regimen.
Clinical Research Studies & Trials
As part of the National Heart, Lung and Blood Institute and the National Institutes of Health-sponsored Heart Failure Research Network, the Massachusetts General Hospital Heart Transplant Program is a regional research center with an active clinical trials program. Researchers in the Heart Transplant Program, along with colleagues from the Mass General Corrigan Minehan Heart Center, are involved in a wide variety of clinical trials. Our goal is to develop new pharmacological agents for the management of heart failure, particularly in the role of pulmonary vascular and right ventricular dysfunction in the progression of heart failure disease.
Developing technologies include:
- Serial heart and autologous stem cell transplantation: We are using serial heart and autologous stem cell transplantation for treatment of cardiac amyloidosis, the buildup of abnormal proteins in the heart. During this process, healthy stem cells from a patient’s own blood or bone marrow are placed in the patient’s body through an IV to help healthy cells develop
- Sildenafil: We are studying the effectiveness of sildenafil (Viagra®) and other drugs in treating patients with primary pulmonary hypertension, a rare lung disease that leads to narrowing of the blood vessels of the lungs
- Diastolic dysfunction: We are investigating the diagnosis and treatment of patients with heart failure and diastolic dysfunction, a condition in which the ventricle (either the left or left and right) of the heart does not function properly during diastole, the phase in which the heart fills with blood that is then returned to the body
Other research areas and clinical trials we are conducting include:
- Studying the role of Rituximab, an agent that depletes B cells, in preventing cardiac allograft vasculopathy, a disease of the blood cells that limits the success of a transplantation months after heart transplantation
- Evaluating the effect of a new drug (tolvaptan) in heart failure patients with decreased kidney function
- Examining the effect of implantable defibrillators on survival and a new form of pacing (called cardiac resynchronization therapy or biventricular pacing) on survival
- Investigating the therapeutic role of nitric oxide in the setting of acute injury to the right ventricle of the heart during a heart attack
- Studying new approaches to the noninvasive diagnosis of graft rejection, as well as new immunosuppressive medications for managing heart transplant recipients who are undergoing evaluation in multicenter, randomized trials
- Studying the role of warm, beating heart preservation in expanding the donor pool
Basic Research Advances Heart Transplantation
In addition to clinical studies and trials available to patients, basic and translational research in heart transplantation is taking place in the Center for Transplantation Sciences (CTS) at Mass General. State-of-the-art molecular and cellular techniques are being used to study transplantation tolerance, acute/chronic rejection, innate immunity, xenotransplantation and whole organ bioengineering in heart transplant models. The overall goal of these investigations is to find ways to provide more patients who are suffering from end-stage heart failure with life-saving organs.