I also have kidney problems. Can more than one organ be transplanted at the same time?

Most patients who have heart failure also experience some degree of kidney problems during the course of their medical illness. The syndrome of heart failure involves a reduced forward pumping of blood out of the heart (reduced cardiac output). The reduced pumping function of the heart diminishes the amount of oxygen-rich blood that is delivered to the vital organs, especially the kidneys. A reduction in adequate blood flow to the kidneys can adversely affect how they function.

Additionally, some other medical conditions that often accompany heart failure, such as high blood pressure and diabetes, can contribute and directly impact the kidneys, which can further compound the problem and can cause additional weakening of the kidney function. Sometimes, the medicines that are used to treat heart failure can actually worsen kidney function, such as diuretics (water pills) or other heart medicines (ACE inhibitors, ARBs, or aldosterone antagonists).

If your kidneys do not function properly, several heart failure conditions may become worsened. If the filtering system of the kidney fails, wastes can accumulate, and certain electrolytes (like potassium) may become unregulated. Abnormal levels of these electrolytes can be dangerous to a weakened heart. It is not uncommon for patients with weakened kidneys to develop higher blood pressure, which may increase the workload to the tired heart. Also, the weakened kidney can have difficulty properly managing your fluid and water status, which can lead to worsened water retention, swelling, bloating, and worsened overall heart failure status.

It is clear that the heart and kidneys need to maintain a delicate balance and have a carefully entwined relationship. Any weakening in either condition adversely impacts the other’s proper functioning. This is often referred to as the cardiorenal syndrome (or, the “heartkidney” syndrome) and can make managing and treating both conditions simultaneously very difficult. Fortunately, for most heart failure patients, when their heart failure improves, so will their kidney function.

Sometimes, however, a patient may develop permanent kidney damage or kidney failure. If this is the case, newer techniques allow patients to be listed for both a heart and a kidney transplant at the same time. The need for combined organ transplantation does not elevate your status on the waiting list. The organs for a patient who requires combined organ transplantation come from a single organ donor, because they will already be properly matched to the recipient.

In other rare circumstances, if a patient has cirrhosis and is otherwise a good candidate for heart transplantation, a combined heart–liver transplantation may be considered. This depends on the level of experience at your individual transplant program.