In 2020, the average cost of a heart transplant in the United States before insurance was $1,664,800. This includes pre- and post-transplant medical care, hospital charges, organ procurement, doctor fees, and medications.

This information comes from the January 2020 Milliman Research Report.

Medicare covers heart transplants, but a person must pay coinsurance and deductibles. Private insurance coverage of the surgery varies among providers and plans.

Candidates for the surgery may include people with end stage heart failure who have found the best medical treatments to be ineffective. However, doctors may exclude individuals with certain conditions, such as cancer, from consideration.

Read on to learn more about heart transplants, including the cost, who may need one, and what to expect before, during, and after the surgery.

A healthcare professional transporting a donor heart in an ice box.Share on Pinterest
Coolpicture/Getty Images

A heart transplant is a type of organ transplant surgery that replaces an affected heart with a donor’s heart.

The surgery involves:

  1. cutting most of the major veins and arteries that attach to the affected heart
  2. removing the diseased heart but leaving behind part of the left atrium, the chamber that receives oxygen-rich blood from the lungs
  3. connecting the donor heart by sewing together the left atria of the two hearts and joining the donor heart to the necessary major arteries and veins

Learn more about the anatomy of the heart.

In 2020, about 3,499 people underwent this procedure.

The stage of heart disease determines whether a person is a candidate for a heart transplant.

The 1-year death rate from a heart transplant is in the range of 10–15%. Due to this, a person’s risk of death from their heart condition should be at least this high.

Healthcare professionals consider individuals as possible candidates if they have advanced end stage heart failure.

This means that optimal treatments have failed to reduce the symptoms or stop the progression of this condition. Primarily, this includes people with nonischemic cardiomyopathy and ischemic cardiomyopathy.

Nonischemic cardiomyopathy refers to heart damage from heart attacks due to heart artery disease.

Ischemic cardiomyopathy is heart damage that stems from factors other than heart artery disease.

Surgeons also perform heart transplants for individuals with valvular heart disease and those who need a retransplant, but this occurs less frequently.

Criteria that rule out a possible candidacy

If a person does meet the above criteria for heart transplantation, it is still possible that a healthcare professional will refuse the surgery.

People will not be a candidate if they have:

  • cancer
  • cirrhosis
  • an active infection
  • advanced kidney disease
  • severe lung disease
  • severe psychiatric conditions
  • severe pulmonary embolism
  • a pulmonary embolism that required treatment within the past 3–6 months
  • a recent stroke or symptomatic and untreated peripheral vascular disease
  • uncontrolled diabetes with end-organ damage
  • a history of finding it difficult to adhere to a treatment plan or follow other medical guidance
  • active smoking or drug use with an unwillingness to quit this use

In 2020, a heart transplant cost an average of $1,664,800.

This includes expenses from:

  • pre- and post-transplant medical care
  • organ procurement
  • hospital charges
  • doctor fees
  • medications

Medicare covers heart transplants. However, a person with original Medicare, which refers to Part A and Part B, must pay the following:

  • 20% of Medicare-approved charges for doctor’s services after meeting the Part B deductible
  • 20% of Medicare-approved charges for medications after meeting the Part B deductible
  • various transplant facility costs

Private insurance coverage of heart transplants varies widely. A person should contact their health insurance provider to ask which costs their policy covers.

People are responsible for all costs that an insurer does not cover.

Below is what to expect before, during, and after the transplant.

Before the transplant

Before the transplant, a person will undergo a complete physical examination and a mental health evaluation.

If healthcare professionals decide that an individual is a good candidate for a transplant, the next step involves waiting for a donor heart that comes from someone who weighs a similar amount and has a compatible blood type.

During the waiting period, people will need to make regular visits to their healthcare team, who will monitor their condition.

During the transplant

Once a compatible donor’s heart becomes available, staff will notify the heart recipient to come to the hospital.

There, the person will receive medication to prevent their body from rejecting the new heart. The healthcare team will give the person anesthesia and begin the operation.

During the operation, surgeons will prepare the person’s chest cavity to receive the new heart. They will remove the old heart and replace it before sewing up the incisions.

After the transplant

Following surgery, recovery occurs in the intensive care unit, which will involve a stay of up to 3 weeks. Cardiac rehabilitation, which is an exercise and education program, may start during this time.

While in the hospital, people will learn how to monitor their overall health and weight, as well as their temperature, pulse, and blood pressure.

Healthcare teams will also teach people how to look out for signs of an infection and detect early warnings that the body is rejecting the new heart.

Throughout the first 3 months after hospital discharge, the person’s healthcare team will ask them to make frequent visits. These visits will test for rejections and infections, check heart function, and assess recovery.

The American Heart Association (AHA) reports that people who undergo a heart transplant do not have any particular activity restrictions. However, an individual should discuss their activity plans with a doctor to ensure that it is safe for them to exercise.

A transplant can help a person have a more active, fulfilling life, but additional heart surgeries or a pacemaker may be necessary in the future.

Individuals can take steps to protect their health. These include:

  • exercising regularly
  • reaching or maintaining a moderate weight
  • taking medications properly
  • keeping all doctor appointments
  • eating a nutritious, balanced diet

If a heart transplant fails, a second heart transplantation may not be possible. It is important to look after the new heart as well as possible.

Heart transplantation is expensive, costing $1,664,4800 in 2020. Medicare covers part of the cost of this procedure, but private insurance coverage may vary.

Healthcare professionals will look at a range of factors to ensure that a person is a candidate for surgery. After the procedure, people will recover in the hospital for up to 3 weeks. Healthcare professionals will closely monitor them for 3 more months.