As donor hearts are scarce, you'll need to be assessed carefully to determine whether a heart transplant is suitable if your doctor thinks you could benefit from a transplant.

A heart transplant may be considered if:

• you have significant heart failure, where the heart is having trouble pumping enough blood around the body (usually the result of coronary heart disease, cardiomyopathy or congenital heart disease)
• you have severe symptoms, despite medical treatment
• you could die within the next few years if you do not get a transplant
• you're otherwise fit enough to survive major surgery

If it's thought you could benefit from a heart transplant, you'll be assessed at a transplant centre to check whether having one is suitable.

An in-depth assessment at a transplant centre is needed to find out more about your health and check whether there are any underlying problems that could affect your suitability for a transplant.

This will usually involve having several tests, such as:

• blood tests and urine tests to check for infections and assess the health of organs, such as your liver
• chest X-rays
• blood pressure tests
• lung function tests
• a CT scan to check the health of organs like your heart and lungs
• an ultrasound scan to assess your kidneys (immunosuppressant medicines can cause kidney problems, so it's important that the current state of your kidneys is checked)
• cardiac catheterisation and coronary angiography, a special type of X-ray used to study the inside of your heart
• an electrocardiogram (ECG) to measure the electrical activity of your heart

You'll also have the opportunity during your assessment to meet the transplant team and find out more about the procedure.

You may find it useful to write down a list of questions you'd like to ask the transplant team before your visit.

Not everyone who could benefit from a heart transplant will be suitable for one.

This is because the operation places a major strain on the body and may mean the risks outweigh the potential benefits.

For example, you may be considered unsuitable for a heart transplant if you:

• have irreversible damage to other organs, such as your kidneys
• have an active infection – this will need to be treated first, if possible
• have cancer – treatment to bring it under control (known as being in remission) will usually be needed before a transplant is considered
• have damaged blood vessels as a result of diabetes
• are living with obesity – you may need to lose weight before a transplant is considered
• drink alcohol excessively or smoke – you may need to stop before a transplant is considered

Age is not a factor in determining whether a heart transplant is suitable, although they're rarely performed in people over the age of 65 because they often have other health problems that mean a transplant is too risky.

The final decision about whether you're suitable for a heart transplant is a joint decision made by the transplant team.

You may be informed about the decision before leaving the transplant centre.

But if your case is not straightforward, it may be several weeks before you're told the decision.

The transplant team may decide you're:

• suitable for a transplant and ready to be placed on a waiting list – read more about being on the heart transplant waiting list
• suitable for a transplant, but your condition does not require a transplant – you'll usually be monitored in case your condition gets worse
• unsuitable for a transplant – the reasons will be explained in detail by your transplant team

In some cases, further tests are necessary to make a final decision, or you may be referred to a different transplant centre for a second opinion.