How Many Heart Transplants Are Performed Each Year?

Roughly 7,000 heart transplants are performed worldwide each year, a figure that has grown slowly over the past decade but still falls far short of the number of people who need one. In the United States alone, about 3,400 adult heart transplants were performed in 2022, while new listings that same year exceeded 4,300. The gap between supply and demand is the defining tension in the field, and nearly every major development in cardiac transplantation over the past several years has been an attempt to close it.

Where Most Heart Transplants Happen

The global total masks a staggering geographic imbalance. About 90% of heart transplants take place in the United States and Western Europe, leaving the remaining 10% spread across the rest of the world.¹ This concentration reflects differences in healthcare infrastructure, organ-donation culture, legal frameworks for brain-death declaration, and funding. Many low- and middle-income countries have no heart transplant program at all. Even within affluent regions, transplant volumes vary considerably from one center to another, and the number of transplants a center performs annually turns out to be one of the stronger predictors of patient survival.²

The Gap Between Need and Supply

The number of people waiting for a heart consistently outpaces the number of transplants performed. In 2022, there were about 4,370 new adult heart transplant listings in the United States but only around 3,370 transplants carried out that year.³ Those numbers do not capture the full scope of unmet need, because many patients with severe heart failure never get listed at all, whether because of age, other medical conditions, or a lack of access to a transplant center.

For people who do make it onto the waiting list, time is not on their side. One study at a major U.S. center found that among patients listed between 2008 and 2013, roughly 85% were alive after one year on the list but only about 57% were still alive at four years.⁴ Waiting-list mortality varies by region and era, but those numbers illustrate why clinicians and policymakers treat every additional donor heart as genuinely life-saving.

Why So Many Donor Hearts Go Unused

One of the more frustrating realities in transplantation is that most potential donor hearts are turned down. In the United States, the majority of offered hearts are declined by transplant teams, and about 60% of the hearts that are ultimately used come from donors younger than 40 with no cardiovascular risk factors.³ Transplant surgeons tend to be conservative. They are, after all, offering a one-shot therapy to a critically ill patient, and using a heart that fails immediately means losing someone who might have survived longer on the waiting list.

The system that connects donors to recipients adds its own friction. Organ procurement organizations, which coordinate the recovery of organs from deceased donors, show surprisingly wide performance differences. A study examining individual hospitals found that the rate at which potential donors were converted into actual donors ranged from 0% to 51%, and two procurement organizations operating in comparable settings recovered donors at rates differing by more than a factor of two.⁵ That kind of variability suggests that organizational practices, staffing, and hospital relationships play a major role in how many hearts actually become available.

How the Donor Pool Is Expanding

Because the traditional donor pool of younger, brain-dead donors cannot keep pace with demand, the field has been pushing in several directions to bring more hearts into circulation.

Donation After Circulatory Death

Historically, transplant hearts came exclusively from brain-dead donors whose hearts were still beating when recovered. Donation after circulatory death, or DCD, involves recovering a heart after the donor’s circulation has stopped, which means the organ endures a period without blood flow. For years this was considered too risky, but advances in preservation technology have changed the calculus. DCD hearts are now increasingly used and are credited with helping transplant volumes grow worldwide.⁶ Early outcome data suggest that DCD transplants can reduce wait times without sacrificing short-term results.⁷

Hepatitis C-Positive Donors

Another source of new hearts comes from donors who test positive for hepatitis C. Until recently, these organs were routinely discarded. The development of direct-acting antiviral drugs that cure hepatitis C in the vast majority of cases has made it feasible to transplant a heart from an infected donor and then treat the recipient. This strategy has expanded the donor pool with younger donors, shortened waiting times, and reduced waitlist deaths.⁸ Studies of recipients who received hepatitis C-positive hearts have found no adverse impact on one-year survival compared to those receiving conventional donor hearts.⁹ Longer-term follow-up is still accumulating, but the approach has already become standard practice at many centers.

Ex Vivo Perfusion

A traditional donor heart is packed in ice and has roughly four to six hours before it must be implanted. That clock limits how far a heart can travel and how thoroughly a surgical team can evaluate it. Ex vivo perfusion systems, sometimes called “heart in a box,” keep a donor heart warm and beating outside the body by pumping oxygenated blood through it during transport. This technology safely extends the window between recovery and transplant and allows surgeons to assess borderline hearts before committing a patient to the operating room.¹⁰ The result is that hearts from more distant donors, and hearts that might otherwise be declined on the basis of uncertain quality, can enter the pool.

How Allocation Policy Shapes the Numbers

In 2018, the United States overhauled its heart transplant allocation system. The old system used a three-tier urgency ranking. The new one expanded to six tiers, with the goal of getting the sickest patients transplanted faster. By most measures, the change has worked. Waitlist mortality dropped, wait times shortened, and a higher proportion of listed patients reached transplantation.¹¹

The new system has also introduced trade-offs. Because the sickest patients are now prioritized more aggressively, hearts sometimes travel farther to reach them, which means longer times out of the body. There has also been a shift toward using temporary mechanical circulatory support devices to keep patients alive and at a high urgency status while they wait, rather than implanting durable left ventricular assist devices (LVADs) that could sustain a patient for years. Whether that shift represents a net improvement or simply a reshuffling of risk remains debated among transplant professionals.¹²

What COVID-19 Did to Transplant Volumes

The pandemic caused a sharp, measurable dip in heart transplant activity. Globally, the number of transplants fell by about 9% in 2020.¹³ Three-quarters of countries performing transplants saw their volumes decline, while a minority managed to hold steady, often in places where organ donation rates remained higher. In 2021, global volumes partially rebounded, recovering about two-thirds of the lost ground, but only one in five countries that had experienced a decline fully returned to pre-pandemic levels by that point.¹³

In the United States, the earliest wave of COVID hit hardest: heart transplant rates fell about 13% below expected levels during the initial surge, with the steepest drops in the hardest-hit states, where transplants plummeted by more than half.¹⁴ Heart transplant volumes in the U.S. largely recovered by the second and third waves, faster than lung transplants, which continued to lag. The pandemic underscored how fragile the transplant pipeline is. Disruptions to hospitals, intensive care unit capacity, and organ procurement logistics can quickly translate into fewer transplants and, by extension, more deaths on the waiting list.

Survival After a Heart Transplant

For those who do receive a new heart, outcomes have improved over the decades but are far from perfect. A population-based study found that ten-year survival after heart transplantation was about 53%.¹⁵ That figure has been gradually climbing: mortality rates relative to the general population declined meaningfully from the early 1990s through the 2000s, driven by improvements in surgical technique, immunosuppression, and post-transplant care.¹⁵

A large analysis of more than 9,400 ten-year survivors found that about 42% of all heart transplant recipients survived at least a decade. Among those who did, the average follow-up extended to 14 years. The strongest predictors of reaching that milestone were younger recipient age (under 55), shorter time the donor heart spent without blood flow, younger donor age, and receiving the transplant at a center that performed at least nine heart transplants per year. Having diabetes before transplant roughly halved the odds of being a ten-year survivor.² The importance of center volume is worth noting for patients navigating the system: where you get your transplant may matter nearly as much as whether you get one.

Disparities in Who Gets a Heart

Access to heart transplantation is not evenly distributed across demographic groups. A national analysis of hospitalizations for chronic heart disease found that patients from the highest-income ZIP codes had higher odds of receiving a transplant than their lower-income counterparts.¹⁶ Income affects everything from insurance coverage to geographic proximity to a transplant center to the ability to comply with the intensive post-transplant medication and follow-up regimen that listing committees evaluate.

Racial disparities are also evident, though the picture is more nuanced than a simple “minority patients get fewer transplants” narrative. In the national hospitalization analysis, Black patients actually had higher odds of receiving a heart transplant than White, Hispanic, and Native American patients when comparing among those hospitalized with chronic heart disease.¹⁶ However, a separate study examining donor heart offer acceptance found that Black candidates had lower odds of having an offer accepted compared to White candidates, an effect that persisted across the first 16 offers.¹⁷ Gender plays a role too: women were more likely than men to have an early offer accepted, but less likely to have later offers accepted.¹⁷

These patterns reflect a tangle of factors, including differences in body size matching, sensitization from prior blood transfusions or pregnancies, clinical decision-making by transplant teams, and systemic issues in healthcare access that determine who gets listed in the first place. The disparities are well documented, but fixing them requires interventions at many different points in the pipeline, from community health outreach to listing criteria to offer-acceptance behavior.

Xenotransplantation and the Search for Alternatives

The arithmetic of heart transplantation is blunt: demand will always outstrip supply as long as we depend on human donors. That reality has fueled research into xenotransplantation, the use of animal organs in human recipients. Genetically modified pig hearts have survived for years in non-human primates, and in 2022, the first pig-to-human heart transplant was performed on a compassionate-use basis in a patient who had no other options.¹⁸ The patient survived about two months before the graft failed, but additional experiments with pig kidneys in deceased human recipients have provided encouraging data.

Xenotransplantation remains years from routine clinical use, if it gets there at all. The immune barriers are formidable, requiring extensive genetic editing of donor pigs and novel immunosuppression regimens in human recipients. Infection risk from pig-origin viruses is another unresolved concern. Still, the growing demand for heart transplantation has made the research more urgent and better funded than at any point in its history.¹⁹

Mechanical assist devices represent a more immediate alternative. Durable LVADs can keep patients with advanced heart failure alive for years, either as a bridge to transplant or as permanent “destination therapy” for people who are not transplant candidates. The relationship between LVADs and transplant volumes is complex. The 2018 allocation changes in the United States shifted some patients away from durable LVADs and toward temporary support devices, which may have affected the number of patients ultimately transplanted and the condition they were in when they reached the operating room.¹² Whether future device improvements will complement or compete with transplantation depends partly on how successfully the donor pool expands through DCD, hepatitis C-positive donors, and improved preservation technology.

Pediatric Heart Transplantation

Children account for a small fraction of global heart transplant volume, but the challenges they face are distinct. The conditions that lead children to need a heart transplant differ from those in adults. In infants, the most common reason is congenital heart disease, while older children more often develop heart muscle disease. The donor pool for pediatric patients is even more constrained than for adults because size matching is critical, especially in very small children, and pediatric organ donors are rare. Wait times can be long and unpredictable, and the use of mechanical support devices in small children is technically more difficult and less well studied than in adults.²⁰ Pediatric recipients who do receive a transplant generally have good medium-term survival, but they face a lifetime of immunosuppression, with cumulative risks of infection, kidney damage, and a specific form of coronary artery disease that affects transplanted hearts. The length of that lifetime, starting in childhood, makes these long-term complications especially relevant.