UPMC is now performing heart transplants for patients who need a transplant but cannot or choose not to receive blood components, including:
- Plasma.
- Platelets.
- Red blood cells.
- White blood cells.
This innovative transplant option will allow more patients to receive lifesaving care at UPMC.
What Is a Heart Transplant for Patients Who Choose Not to Receive Blood?
This type of heart transplant is a surgical procedure that doesn’t require blood transfusions. During the surgery, the team works to minimize blood loss and avoid the need for a transfusion.
This advanced surgery allows UPMC to offer heart transplants without compromising a patient’s religious or personal beliefs.
Who Is a Candidate for Heart Transplants Performed Without Blood Transfusions?
To be a candidate for heart transplant without blood transfusions, the transplant team may ask you to:
- Increase iron intake through diet changes and supplements.
- Stop drinking alcohol and smoking.
- Stop taking over-the-counter pain medication and anti-coagulants.
- Stop taking vitamin E and fish oil at the time you are placed on the transplant waiting list.
- Take folic acid for blood optimization.
You are not a candidate for heart transplant without blood transfusions:
- If you had a previous open heart surgery.
- If you had a left ventricular assist device (LVAD) implanted.
What Happens Before a Heart Transplant Without Blood Tranfusions?
Before undergoing the heart transplant, you’ll meet with various specialists to prepare for the surgery. This includes:
- Experts from the UPMC Center for Perioperative Care (CPC).
- The UPMC Patient Blood Management team.
- The UPMC Heart Transplant Program team.
First, you’ll meet with the Patient Blood Management team. You can do this through telemedicine if you are traveling for care. During this consultation, you can discuss your personal blood choices with the doctor.
Next, you’ll go through the heart transplant evaluation process. This includes:
- A review of your medical history.
- Blood work.
- Diagnostic tests.
- Multiple consultations.
Following these tests and consults, the heart transplant team will determine if you are a candidate for transplant. If you are a candidate, you will be placed on the transplant waiting list.
As you wait for their transplant, you will have a consultation with the CPC team. They will assess you and make recommendations to help lower risks during surgery. The CPC’s mission is to find and reduce factors that put people at risk during surgery. To lower these risks, our team will address your:
- Anemia management.
- Anesthesia concerns.
- Chronic pain needs.
- Mental health issues.
- Need for access to social work support.
- Need for physical, heart, or lung therapy.
- Need for weight loss.
- Nutritional status.
- Tobacco, drug, and alcohol use.
The team also may recommend that patients begin taking supplements to improve their blood count before surgery. This includes iron, erythropoietin (EPO), oral folate, and vitamin B12 supplements.
What Happens During Heart Transplant Surgery for Patients Choosing Not to Receive Blood?
During the procedure, the surgical team will collaborate to limit the amount of blood loss. There are various techniques used to control blood loss, including:
- Cardiopulmonary bypass — This machine is used during cardiac procedures. It temporarily takes over the function of the heart and lungs so that the heart can be stopped for surgery. The machine diverts blood and adds oxygen before returning the blood to the heart.
- Cell saver — If a patient permits, the team will use a cell saver machine to collect lost blood during surgery and recycle it back into the patient’s body.
- Meticulous hemostasis — This technique involves carefully controlling bleeding during each step of the surgery. The team uses electrocautery, a technology that uses an electric current to stop bleeding. Hemostatic agents, such as bone wax, also can be applied to manage surgical bleeding.
- Thromboelastography (TEG) — This technology monitors blood clotting during surgery. It can predict the need for blood transfusion and reduce blood product use during the procedure.
What Happens After a Heart Transplant Without Blood Tranfusions?
After surgery, you will stay in the hospital to recover. The heart transplant team will monitor you. Your care team will minimize the amount of blood work performed to conserve blood in your body.
You also should continue taking supplements to improve your blood count.
Why Choose the UPMC Heart Transplant Program?
The UPMC Heart Transplant Program follows each patient over their lifetime to monitor their heart function. From transplant evaluation to post-transplant care, our team is here to support you every step of the way.
Our program is one of few that has heart recipients living 30 years or more after transplant. Our team’s dedication to surgical excellence and patient-centered care has allowed us to maintain outstanding patient outcomes.
For more information or to make an appointment for a heart transplant evaluation, call 412-648-6202 or email cttransplant@upmc.edu.