How do you know when it’s time for a second heart transplant?

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The heart transplant world is full of highs and lows. My colleagues and I experience them every day with our patients and their families.

For example:

  • Low: Your daughter needs a new heart. Even though needing a new heart means we have an active game plan in place for your little one, this news is often a blow to parents. Now they have to prepare physically, emotionally and financially for a transplant.
  • High: Four weeks later, we have a heart for her. She’s getting a second chance.
  • Low: Six years later, your daughter needs a new heart…again. The cycle starts all over.

Of course, there are tons of other highs and lows in between. These are just a few of the major ones. And that last one, a
bout needing a second heart transplant, is a fear rooted in the minds of many heart transplant parents.

Also read: Can Parents Experience PTSD from Their Child’s Heart Condition?

The kids may be too young to realize that they may someday need another new heart, but parents worry. It’s what we do.

But how do you know when it’s time for a second heart transplant?

Symptoms That A Transplanted Heart Is Failing


A second transplant could be needed two years after the first one—or 25 years. Hearts don’t come with expiration dates so re-transplant is difficult to predict.

We monitor the heart closely with echocardiograms, EKG’s and heart catheterizations. To treat issues we run into, we adjust medications or try different ones. Sometimes, we have to do some intervention in the cath lab.  Whatever the change in treatment, we have to give it some time to work and see how the child responds.

By taking conservative approaches, we can potentially postpone the need for a repeat heart transplant for a long time.

Also read: How anti-rejection drugs work

Throughout this process, it’s important that parents keep one fact in mind :a heart transplant is not a cure. I remind myself of that regularly. Maintaining a healthy heart is a lifelong commitment.

How Many Heart Transplants Can A Person Have?

A third heart transplant is possible, but does not happen routinely. That’s because the body starts experiencing antibody issues. No matter what regimen of medications we try, antibodies can form thus rejection is a very real threat.


An isolated episode of acute rejection can be treated with anti-rejection drugs. However, chronic rejection is the leading cause of transplant failure, according to the National Institutes of Health.

No Matter What, Try Not to Worry

Worry and fear can eat you alive. Your child needs your support after heart transplant. So don’t waste too much time worrying about round two.

I’ve heard success stories from heart transplant survivors who are 20 years or more post-transplant. The National Institutes of Health puts survival rates beyond 10 years as long as organ rejection can be controlled.

Besides, it’s better to focus on the present. Receiving a new heart and recovering from transplant surgery is a major accomplishment. Instead of worrying, spend that time celebrating your child’s second chance.

Barb Roessner

Hi, I'm Barb, and I'm a Physician Assistant and coordinator of the Heart Failure and Transplant Program at Children's Hospital & Medical Center in Omaha. I work with patients and families at every step of the journey, from diagnosing their child's heart condition to my favorite part—calling them to say "We have a heart."

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