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The Process of Undergoing a Heart Transplant

Dr. Andrew Kolodziej gives patients information about heart transplants.
The Process of Undergoing a Heart Transplant
Featured Speaker:
Andrew Kolodziej, MD
Dr. Andrew R. Kolodziej obtained his medical degree from Ross University School of Medicine in Miramar, Fla. He then completed a residency in internal medicine through Yale University School of Medicine at Norwalk Hospital in Norwalk, Conn., where he also served as a chief resident. He completed cardiovascular training, which included both general cardiology and a fellowship in advanced heart failure and transplant, here at the University of Kentucky. 

Learn more about Andrew Kolodziej, MD

Melanie Cole (Host):  The Heart Transplant Program at UK Transplant Center offers comprehensive care for transplant patients. Here to tell us about that today is my guest Dr. Andrew Kolodziej. He’s the Medical Director of the Heart Transplantation at UK Health. Dr. Kolodziej, welcome to the show. I’m so glad to have you with us today. Let’s start by setting the stage a bit. How common is heart transplant? How many are performed on a yearly basis?

Andrew Kolodziej, MD (Guest):  Thank you for having me. Heart transplant has been a lot more common in the last several years specifically over the last five years or so and specifically in our program, we have been doing around 30 transplants every year for the last couple of years.

Host:  Wow. So, tell us a little bit about heart transplant itself. What conditions generally, eventually lead to transplant and what patients qualify?

Dr. Kolodziej:  Absolutely. So, the most common reason for transplant is somebody who has a very weak heart muscle with what we call an ejection fraction which is ultrasound evaluation of how well the heart squeezes; anybody that has an ejection fraction of less than 25% along with symptoms that land them in emergency rooms and hospitals often; are the patients who we often start looking at for transplant.

Host:  So, then tell us a little bit about what someone can expect, once they’ve been placed on the transplant list. I think Dr. Kolodziej once of the questions when people hear transplant of any kind but especially something huge like the heart; what is that waitlist experience like? How is wait time calculated? What is it like for the patient?

Dr. Kolodziej:  So, there are certain levels of patients who are on the waiting list and it all depends on how sick they are; if they can potentially wait at home versus somebody who will need to stay in the hospital and wait for a heart transplant. Those are divided in different levels. So, the people who are on life sustaining machines sitting in the hospital are on the top list. Those are the patients who usually will get a heart within days to weeks. Follow that by somebody who remains on life sustaining medicines who do not require machines for life support will usually wait between one to two weeks to maybe a month or two.

It also depends actually on their antibody levels and how quickly we can find somebody who actually fits their size and their antibody profile. And then lastly, somebody who can actually wait at home are lower down on the list because of the fact that they do have a little bit more time and we can safely wait for the transplant of the organ. Those are the people who usually will wait sometimes up to a year or so. And so, there’s a pretty rigorous evaluation process to look into all of these aspects and we finally meet with a committee that comprises of several heart transplant cardiologists as well as surgeons in addition to the nurse practitioners, social workers and such to determine what else they need to be a good candidate and sometimes that will take a couple more weeks to sort of put things together such as finances and make sure the patients have social support at home to be able to go through this process. So, all of that plays into the decision making.

Host:  So, it’s a very comprehensive and multidisciplinary program which I’m sure many people don’t even realize. So, tell us about the donor. How is that matched up to the recipient and then what happens once somebody – a donor has been found and maybe the person is in the hospital and has been on sustaining equipment; what’s it like? What is the process like as they start to go through this?

Dr. Kolodziej:  Sure. So, once we figure out where the patient can be, which level they can be listed at, as well as what their antibodies are and once we figure out all these steps, then we essentially wait for a phone call from a procurement sort of agency. So, they usually receive a phone call from hospitals where the potential donor is. They screen the donor for specifications that are set forth by a national governing body and once the preliminary screening seems to fit the profile; then they look through a list of patients that are in that region. That usually is several states wide. And then once they look through the list, then they call the particular facility speaking to either the surgeon or the cardiologist and then we screen the donor and the organ itself and scrutinize it and make sure it fits our specifications.

Once we agree that this is a good donor and a good organ; then we literally call the patient and let them know there’s a donor, fits the profile, meaning the weight as well as antibodies and if the patient accepts; we go out to get the organ. Now ultimately, the decision whether we take the organ or not will depend on the surgeon who will physically take a look at the organ, touch the organ, make sure everything looks to be to our specifications before we actually have the recipient or the patient that is waiting for the organ on the OR table and ready to have their chest opened.

And that usually gives the patient around two to three hours. Usually within two hours, we ask them to come to the hospital to start getting ready for the surgery.

Host:  Dr. Kolodziej, people see on TV, on television shows how exciting it seems and heart thumping as it where to go get that heart and bring it. Is it really like that and then tell us a little bit about after the procedure. How long can you expect a heart transplant to last? Is there a life expectancy? Is there a way to tell if rejection is possible? Speak about after it.

Dr. Kolodziej:  So, certainly. It is just as exciting as what it may seem to be on the TV. It is a very important process, and everybody treats you as if you are transporting a precious commodity and in fact it is. When we fly out to get these organs, we do have the agency waiting for us to pick us up from the airport, they take us to the hospital, wait for us there, bring us back to the airport with lights and sirens and then finally when we land in our local airport; an ambulance usually waits for us and takes us to the hospital as quickly as we can get here.

The problem with the heart, it can only stay out of the body so long. Our cutoff is usually no more than four hours. So we try to obviously make it much sooner than that as it will take another half an hour to forty five minutes to prepare the organ for surgical specifications to fit the chest and accommodate the recipient or the patient that’s waiting for the organ.

As far as post-transplant; patients are quite immunosuppressed so they take a lot of medicines that will decrease their chances of fighting infection, so there’s always a potential that they can become infected with either viruses or bacteria. So, they ultimately take a lot of medicines not only to suppress their immune system but also prevent certain infections. So, that comes with a lot of medications moving forward. The first year is usually the most critical because we tend to give a lot of immunosuppression meaning we keep the levels of immunosuppressive medicines pretty high to prevent rejection. And we can always deal with infections and such complications as they come along.

As far as longevity of the organ or how long the patient would benefit from the new organ; obviously, none of these are perfect because of we discovered immunosuppressive medicines, we have come a long way. And now the median survival of the organ or how long the organ lasts before it starts giving the patient any trouble is around 13 years. We do have patients who have been out from transplant up to about 20-25 years. So, it all depends sometimes on ultimately how the patient takes care of it’s graft, it’s organ, how they eat, how they exercise, the take their medications appropriately. Everything else we would do for any other disease process.

Host:  Isn’t that fascinating? I am just amazed by this kind of technology and surgery and what it can do to change the lives of people with various forms of heart disease. As we wrap up, Dr. Kolodziej, what kind of lifestyle changes does someone need to make? What would you like them to know about heart transplantation and why they should look to UK Health for this type of care?

Dr. Kolodziej:  Well moving forward after a heart transplantation, the patient is always encouraged to lead a healthy lifestyle such as plant-based diet, a lot of exercise, following our directions, obviously, just like with any other disease state that specifically affects the heart.

We do a significant amount of transplants here. We have a great and experienced staff that includes both specifically trained heart transplant cardiologists, as well as multiple surgeons. That gives us an opportunity to transplant patients more often than many other facilities. As well was we have coordinators who are nurses who are specifically interested in post-transplant care who are first contacts for the patients. In our situation, these nurses are local, they go out to meet their patients and go out of their way to make sure there are no complications and if anything arises; they stay on top of this much more than I’ve experienced anywhere else.

Host:  Wow. Such an interesting segment. Thank you so much Dr. Kolodziej for coming on and sharing your incredible expertise and telling patients about something that sometimes really seems very mysterious. So, thank you so much for joining us today.

That wraps up another episode of UK HealthCast with the University of Kentucky Healthcare. For more information on heart transplantation at UK Health head on over to our website at If you found this podcast as cool as I did, share it with your friends. We are learning from these experts together and the information is really fascinating. And don’t forget to check out all the other interesting podcasts in our library. Until next time, I’m Melanie Cole.