Transplant

Indiana University Health Transplant provides the highest quality of care and range of services for our pancreas, intestine, liver, kidney, multivisceral, heart and lung transplant patients as well as our adult congenital and ventricular assist device patients.

Patients come from all over the Midwest and beyond to Indiana University Health for highly skilled surgeons and advanced operating facilities. As a transplant team, we provide comprehensive transplant services resulting in excellent outcomes and national recognition. We are committed to continuous quality improvement, demonstrated by our surgical, medical and interventional outcomes, as well as the clinical research activity and high patient volumes. As a state and regional referral resource for the most complex and advanced disease problems, we are the only program in Indiana approved by Medicare to perform lung and heart-lung transplantation.

Indiana University Health Methodist Hospital Transplant offers more advantages including:

  • A nearly 30-year record of accomplishment of cardiothoracic transplant specialists caring for patients at IU Health Methodist Hospital and Riley Hospital for Children at Indiana University Health. As a “heart hospital” within a full-service tertiary/quaternary facility, we give patients with advanced heart and lung disease immediate access to all specialties and treatments.
  • Indiana University Health LifeLine, the state’s longest-running, largest emergency aeromedical transport system, ensures patients across the state are transported in the shortest time to the facility best suited for their emergency needs—one of our two Level I Trauma Centers.
  • An Advanced Heart Care Program on the forefront of clinical advancement in heart failure care, heart transplant and ventricular assist device (VAD) services. The program incorporates both inpatient and outpatient services that span the continuum of care for patients with advanced or recurrent heart failure, including collaboration between pharmacists, psychologists, nurses, social workers, cardiologists and surgeons.
  • A comprehensive lifetime care program to meet the ongoing medical needs of adults living with congenital heart disease. Our Adult Congenital Heart Disease (ACHD) Program is the only program in Indiana recognized by the Adult Congenital Heart Association. It offers access to complex diagnostic cardiac catheterization and trans-catheter interventions, as well as the latest technologies in valve replacement and defect closure devices.

In 2012, IU Health Methodist Hospital was designated as a Blue Distinction Center in the area of adult heart transplants by Anthem Blue Cross and Blue Shield. Blue Distinction Centers for Transplants have demonstrated their commitment to quality care, resulting in better overall outcomes for transplant patients. Blue Cross Blue Shield Association (BCBSA) awards Blue Distinction® recognition to facilities which meet objective, evidence-based thresholds for clinical quality in collaboration with expert physicians and medical organizations.

Together with the Indiana University School of Medicine, we provide unparalleled experience in transplant research and innovation. 

Heart Transplant

Indiana University Health Heart Transplant is one of the oldest centers in the nation, providing expertise in caring for heart failure patients for almost 30 years. Since the program’s inception in 1985, our surgeons have performed more than 600 adult cardiac transplants and taken on some of the most challenging heart failure cases. We provide a comprehensive range of therapies using a multidisciplinary approach, which allows our physicians to optimize treatment and outcomes for patients.

Our team of healthcare professionals recognizes that a heart transplant is not simply a surgery. We help you prepare both emotionally and physically. A large integrated team of surgeons, physicians, transplant nurses, pharmacists, social workers and others works together to manage every aspect of your journey from transplant planning through post-transplant care.

Our smallest patients receive the same innovative care from the pediatric cardiothoracic transplant specialists at Riley Hospital for Children at IU Health. Comprised of the divisions of Cardiovascular Surgery, Pediatric Cardiology and the Riley Heart Research Center, the Riley Heart Center at IU Health is internationally recognized as a leader in treating children with heart disorders. The cardiac medical and surgical team is the only group performing pediatric heart transplantation in Indiana. This has led to many of the advances in treating children with failing hearts.

Highlights of the Heart Transplant Program include:

  • Cardiologists who are dedicated to advanced heart failure care and heart transplant
  • Cardiac surgeons experienced in advanced heart failure mechanical devices surgery and cardiothoracic transplant
  • Heart transplant nurses, each with over a decade of transplant experience, who coordinate pre- and post-transplant care
  • A cardiothoracic transplant pharmacist
  • Exclusive outpatient heart transplant clinic, housing the team of transplant physicians, surgeons, nurse coordinators, psychologists and social workers
  • Exclusive inpatient transplant unit dedicated to post-transplant care and all transplant-related conditions

Heart Transplant Procedure

If you are listed to receive a heart transplant, naturally you and your loved ones want to know exactly what to expect. The team of cardiothoracic specialists at IU Health Methodist Hospital is here to provide you with the highest level of care throughout the entire transplant process.

Once a suitable donor has been identified and evaluated by the procurement surgeon, you are given general anesthesia and hooked up to monitoring devices. These devices allow the transplant surgeon and the anesthesiologist to assess your hemodynamic (blood circulation) status before, during and after the transplant. Your chest is then opened through a median sternotomy (through the middle of the breast bone). The heart is exposed and prepared to go on the cardiopulmonary bypass (the heart-lung bypass) machine.

When the new (donor) heart arrives in the operating room, the transplant surgeon does an additional inspection of the new heart and prepares it for implantation. Then you are placed on cardiopulmonary bypass and cooled. Your old heart (native heart) is removed by transecting the aorta, the pulmonary artery, dividing the superior and inferior vena cava from the right atrium and then opening the left atrium. The pulmonary veins remain attached to a cuff (back wall) of the left atrium.

The new heart is then placed in the pericardial space (a space where the old heart resided) and the left atrial cuff of the new heart is sewn to the left atrial cuff of the native heart using a permanent suture. Then, the inferior vena cava of the donor heart is sewn to your inferior vena cava and, likewise, the donor superior vena cava to your superior vena cava. Once these connections have been completed, the donor’s aorta is matched for size and length to your aorta and then sewn together. The pulmonary artery is also matched for size and length and sewn together. Your new heart is now implanted.

You are warmed to a normal body temperature with a cardiopulmonary bypass machine. After removing any air within the heart and great vessels, warm blood is perfused (returned) into the heart. You are given an initial dose of anti-rejection medication (steroids). The new heart is allowed to recover from the implant ischemia (normal lack of perfusion to the heart) for about 30 to 45 minutes and medicines to assist the function of the new heart are given and adjusted at this time.

Now with the heart beating normally and your blood pressure and pulmonary artery pressure in an acceptable range, you are weaned slowly from cardiopulmonary bypass. Chest drainage tubes are placed to help drain any blood or fluid that may accumulate around the heart. These tubes are temporary and will be removed, on average, three to four days after the transplant. Your sternum is closed with surgical stainless steel wires and you are taken to the cardiovascular intensive care unit for careful monitoring.

Heart Transplant Outcomes

Indiana University Health Methodist Hospital Heart & Vascular Care is dedicated to providing the highest quality care and services for our heart transplant patients and committed to continuous quality improvement, which is demonstrated by our surgical, medical and interventional outcomes.

Despite taking on some of the most challenging cases, our outcomes are the result of our extensive expertise in caring for heart failure patients. We ensure you remain healthy and strong before, during and after transplant. We also provide supportive care for recovery and your return to daily activities.

Mechanical Circulatory Support

In addition to our history of many transplant “firsts,” we continue to refine many transplant techniques. We also care for the most complex adult and pediatric heart failure patients, providing lifesaving therapies to end-stage heart failure patients not available in most hospitals.

Our Ventricular Assist Device (VAD) Program has been helping heart transplant patients for over 25 years and serves as a national training site for physicians and other allied health providers. Certified by The Joint Commission for destination therapy since 2008, our program is actively involved in numerous clinical trials and offers a variety of options to meet your needs. Technological advances, including miniaturized, non-pulsatile assist devices, are routinely used to help many patients return to an active lifestyle.

Technological advancements have led to improved survival for patients at both one month and six months after transplant. Approximately 75 percent of heart transplant patients receive a VAD while waiting for their transplant. IU Health serves as a referral center for the state of Indiana, treating the most complex advanced heart care patients.

Extracorporeal membrane oxygenation (ECMO) provides cardiopulmonary bypass support for pediatric and adult patients with severe but potentially reversible forms of cardiovascular or respiratory failure. Initially introduced as a treatment for many childhood disorders, ECMO is also used as a bridge for adult patients with severe respiratory or cardiac failure to recovery from other surgical therapies.

Unique to IU Health, both the adult and pediatric ECMO programs are accredited by the Extracorporeal Life Support Organization (ELSO).

ECMO is applied in two forms:

  • Veno-venous ECMO for respiratory support
  • Veno-arterial ECMO for cardiopulmonary support

ECMO provides immediate resuscitation to allow the lungs or heart to recover. It may also be used as a bridge to a VAD or transplant (heart or lung). We provide ECMO technology for both pediatric and adult patients at Riley Hospital at IU Health and IU Health Methodist Hospital campuses.

The ECMO circuit includes a pump, oxygenator, tubing and vascular access. It continuously pumps your blood through an oxygenator that imitates the processes of the lungs. The blood is then re-infused into a major artery or vein, similar to cardiopulmonary bypass. Your thoracic surgeon performs cannulation, which connects your body to the ECMO machine. A team of surgeons, pulmonologists, perfusionists, respiratory therapists and specially trained nursing staff monitors you and your care.

Lung Transplant

For over 20 years, the Indiana University Health Thoracic Transplant team has performed lung transplants at IU Health Methodist Hospital. As the state's only Medicare-approved lung transplant program, our extensive experience includes over 600 transplanted patients. Our multidisciplinary team of pulmonologists, cardiothoracic surgeons, transplant pharmacists and support staff are recognized as experts in the field of lung transplant.

Our program is constantly evolving to improve your transplant experience and ultimately improve survival rates. You are assigned a pre-transplant coordinator to help navigate the complex road leading to transplant. In a seamless transition, you are assigned a post-transplant coordinator for life to assist with any hurdles you may face following transplant. We also offer a rigorous pre-transplant conditioning program that includes both physical and respiratory therapies to help maximize survival rates.

First, a suitable donor is identified and evaluated by the procurement surgeon. When it is time for surgery, you are given general anesthesia and attached to monitoring devices. A special tube is positioned in your airway to facilitate isolation of your lungs to allow for single lung ventilation while one lung is being implanted.

There are two types of surgical incisions used for lung transplantation:

  • Single lung transplant. The recipient’s chest is opened through a single thoracotomy (incision either on the left or right side of the chest).
  • Double lung transplant. Sequential thoracotomies (opening one side first and then the other side), a clamshell incision (opening the chest from the front and dividing the lower sternum) or a median sternotomy (through the middle of the breast bone) may be used.

The choice of incision and the need for cardiopulmonary bypass (heart-lung bypass) is determined by the patient’s disease process and clinical condition at the time of surgery. When the new (donor) lung(s) arrive in the operating room, the transplant surgeon does a final inspection of the new lung(s) and prepares for implantation.

Your diseased (native) lung is removed first by stapling the pulmonary artery, then each individual pulmonary vein (superior and inferior pulmonary vein). These vascular structures are cut, leaving the stapled stumps attached to your heart. After the bronchi are divided and left open, the bronchus (major air passages of the lungs) of the donor is sewn to your bronchus using permanent sutures.

Next, a small clamp is placed across your pulmonary artery and the staple line is removed. The donor pulmonary artery is then matched for size, length and orientation with respect to your artery and then connected with fine permanent sutures. In a similar way, a clamp is placed across the left atrium where the two pulmonary vein stumps drain into the left atrium. The staple lines are removed and your pulmonary veins and recipient are sewn together.

Once these three connections are completed, you are given an anti-rejection medicine (steroid), the small clamp on the pulmonary artery is removed and air is evacuated from the blood vessels of the lung. The clamp on the pulmonary veins is removed and then the lung is ventilated. This procedure is repeated on the opposite side if a double lung transplant is performed.

Drainage tubes are placed within your chest cavity (chest tubes) to help remove any fluid, blood or residual air in the chest cavity. These tubes are temporary and are usually in place for four to five days. Your chest is then closed and you are transported to the cardiovascular intensive care unit for careful monitoring.

Lung Transplant Outcomes

Indiana University Health Methodist Hospital lung transplant has over two decades of experience and has performed a wide variety of transplants, often for the sickest patients. As the only lung transplant program in the state, we performed 62 lung transplants in 2014 placing us among the top 10 programs nationally by volume.

Read more about IU Health lung transplant outcomes.

Additional Contact Information

For Patients
For additional information, contact: 317.962.8677 or 800.510.2725. You can also contact us by email at transplantinfo@iuhealth.org.

For Physicians
Contact the cardiothoracic transplant specialists at IU Health:
Advanced Heart and Lung Care Center
Indiana University Health Methodist Hospital
1801 N. Senate Blvd.
MPC# 2, Suite 2000
Indianapolis, IN 46202
Call direct: 317.962.8677 or 800.510.2725