A heart-kidney multi-organ transplant is major surgery to replace your diseased heart and kidney with healthy organs. You may need this surgery if your heart and kidney are so severely diseased or injured that they cannot be treated or repaired. Certain chronic medical conditions can eventually lead to both end-stage heart disease and kidney insufficiency that might require this surgery. A heart-kidney transplant may be considered if no other treatments have been successful.

In this procedure, the diseased heart and kidney are both replaced with the donor heart and kidney. Both organs usually come from the same donor.

You will work with a team of health care providers (transplant team) to help you prepare for the procedure. Suitable donor organs need to be found that are a good match for your blood type and body size. Until then, you will be on an organ transplant waiting list.

Tell your health care provider about:

  • Any allergies you have.

  • All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.

  • Any blood disorders you have.

  • Any problems you or family members have had with anesthetic medicines.

  • Any surgeries you have had.

  • Any medical conditions you have.

  • Whether you are pregnant or may be pregnant.

What are the risks?

This is a complex surgery. Problems may occur, including:

  • Bleeding.

  • Infection.

  • Damage to nearby structures or organs.

  • Allergic reactions to medicines.

  • Rejection of the transplanted organs.

  • Death.

What happens before the surgery?

Waiting list and notification

  • You will be put on a transplant waiting list. When you are placed on the waiting list, the transplant team will tell you how to prepare for the time when a heart and kidney become available.

  • While on the waiting list:

    • Do not drink alcohol.

    • Do not use any products that contain nicotine or tobacco. These products include cigarettes, chewing tobacco, and vaping devices, such as e-cigarettes. If you need help quitting, ask your health care provider.

  • Once you are notified that a donor heart and kidney are available, you will be given instructions by the transplant team to come into the hospital right away or to await further instructions.

Staying hydrated

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Follow instructions from your health care provider about hydration, which may include:

  • Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

  • 8 hours before the procedure – stop eating heavy meals or foods, such as meat, fried foods, or fatty foods.

  • 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.

  • 6 hours before the procedure – stop drinking milk or drinks that contain milk.

  • 2 hours before the procedure – stop drinking clear liquids.

Medicines

Ask your health care provider about:

  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.

  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines unless your health care provider tells you to take them.

  • Taking over-the-counter medicines, vitamins, herbs, and supplements.

Tests

You will have exams and testing. These may include:

  • A physical exam.

  • Blood or urine tests.

  • Additional tests to help make sure you are fit enough to have this surgery.

General instructions

Ask your health care provider:

  • How your surgery site will be marked.

  • What steps will be taken to help prevent infection. These steps may include:

    • Removing hair at the surgery site.

    • Washing skin with a germ-killing soap.

    • Taking antibiotic medicine.

What happens during the surgery?

  • An IV will be inserted into one of your veins.

  • You will be given one or more of the following:

    • A medicine to help you relax (sedative).

    • A medicine to make you fall asleep (general anesthetic).

  • The surgical team will make incisions to open your chest and abdomen.

  • Your diseased kidney may be left in place or removed. When the surgeon is putting the new kidney in place:

    • The blood vessels of the new kidney will be attached to the blood vessels in the lower part of your abdomen.

    • The tube that connects the kidney to the bladder (ureter) of the donor kidney will be connected to your bladder.

  • During the surgery, you will be connected to a heart-lung bypass machine. This allows blood to continue to flow through your body while your heart is removed.

  • After the heart is removed, the surgeon will sew the donor heart into place and connect the blood vessels.

  • When the donor heart is fully connected, the blood in the bypass machine will be allowed back into the heart, and the tubes to the machine will be removed.

  • Your new heart will be shocked to restart the heartbeat and will be examined to make sure there are no leaks.

  • After the donor organs are in place and connected, your chest and abdomen will be closed with stitches (sutures) or staples.

  • Surgical drains or tubes may be put in place to drain fluid and help you heal.

  • Bandages (dressings) will be placed over the incisions.

The procedure may vary among health care providers and hospitals.

What happens after the surgery?

  • Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until you leave the hospital.

  • You will stay in the hospital for monitoring for several days.

  • You will be started on medicines to prevent your body from rejecting the transplanted organs.

Where to find more information

Summary

  • A heart-kidney multi-organ transplant is major surgery to replace your diseased heart and kidney with healthy organs.

  • A heart-kidney transplant may be needed if no other treatments have been successful.

  • You will work with a team of health care providers (transplant team) to help you prepare for the procedure.

  • In this procedure, the diseased heart and kidney are both replaced with the donor heart and kidney. Both organs usually come from the same donor.

This information is not intended to replace advice given to you by your health care provider. Make sure you discuss any questions you have with your health care provider.