Every heart transplant program is built for the moment when medicine reaches its edge, when a patient’s heart can no longer be repaired, only replaced.
At Penn State Health Milton S. Hershey (Pa.) Medical Center, that moment is approached with uncommon precision. The health system has achieved a 100% three-year survival rate for heart transplant patients, marking the second time it has reached that milestone, according to the latest Scientific Registry of Transplant Recipients data.
The performance places the program among the strongest in the nation, well above the national three-year survival average of 85%.
For Behzad Soleimani, MD, chair of the department of surgery at the center and director of the Penn State Heart and Vascular Institute, also in Hershey, the headline is not simply the number. It is what the number reveals about the system underneath.
This year’s national data reflects not only survival, but survival measured against what was statistically expected.
“What’s remarkable and unique this time around is that what’s reported is not just survival percentage, but survival with respect to expected survival,” Dr. Soleimani said.
Expected survival accounts for patient risk factors and comorbidities, offering a clearer view of how medically complex a transplant population truly is.
For Penn State’s most recent cohort, expected three-year survival was 85%. Actual survival was 100%.
“What we’ve been able to accomplish this time around, for the first time, is best-in-the-nation observed-to-expected survival,” he said. The distinction matters. It means these outcomes were not achieved by taking only lower-risk patients.
“We accomplished 100% survival by not just being selective,” Dr. Soleimani said. “It’s more of an accomplishment when statistically, they are less likely to survive.”
A team — and a “team of teams”
Transplant leaders often speak about multidisciplinary care. Dr. Soleimani describes something more demanding: coordination without margin for error. “All these elements have to be done perfectly,” he said. “You want to have a perfect result. There is no opportunity or no margin for error.”
Heart transplant success depends on an entire continuum, advanced heart failure care, the transplant operation itself, immediate post-operative management and years of long-term follow-up.
At each stage, teams must function not only at a high level individually, but seamlessly together. “There is a team of teams,” Dr. Soleimani said. “The interplay between the teams has to be seamless.”
The paradox at the center of long-term survival
The most defining feature of Penn State’s transplant philosophy, Dr. Soleimani believes, is an irony: the best transplant outcomes begin with doing everything possible to avoid transplant in the first place.
“The biggest reason why we have such an outstanding long-term survival after heart transplant is that we do everything we can to avoid a heart transplant,” he said.
That approach is rooted in preserving the whole patient long before surgery becomes inevitable. Heart failure can weaken kidney function, liver function, lungs and muscle mass over time. Penn State’s goal is to ensure that when transplant does happen, the heart is the only failing organ.
“When they do end up needing the heart transplant and they come to the operating room, everything else works, except the heart,” Dr. Soleimani said.
Replacing the heart then becomes not only lifesaving, but restorative. “You change the heart,” he said, “and they get a new lease on life.”
That preparation extends far beyond the transplant team itself, encompassing preventive cardiology, coronary interventions, bypass surgery, valve procedures and structural heart care, all designed to delay transplant while strengthening patients for the long journey ahead.
Zero waitlist mortality: survival before surgery
Penn State also recorded zero waitlist mortality during the July 2023 to June 2025 rating period, meaning no patients died while awaiting a donor heart.
Dr. Soleimani views that outcome as another reflection of the same vigilance. The waitlist period, he said, is often the most fragile chapter in a transplant patient’s life. “We can’t control the timing,” he said. “We have to wait for the right size donor. So you are the most vulnerable.”
Patients awaiting transplant are watched “ultra vigilantly,” he added, with the priority not only getting them to surgery, but getting them there strong enough to thrive afterward.
Excellence after the operating room
Survival does not end when surgery is over. Post-operative care requires the same team-of-teams approach, spanning intensivists, heart failure cardiologists and surgeons who remain involved long after the procedure.
“You need defense, offense, special teams,” Dr. Soleimani said. “All not just doing well individually, but working as a team together.”
Long-term outcomes depend on vigilant management of immunosuppression and early detection of rejection. “We have a very committed and dedicated team of coordinators,” he said, “available for patients to call if something doesn’t feel right.”
Patients can be brought in quickly, biopsied and treated before complications escalate.
Trust as a clinical intervention
Long-term transplant survival is often framed in technical terms: immunosuppression protocols, rejection surveillance, biopsy timing. But Dr. Soleimani is clear that another variable is just as decisive: trust. “It’s important to build a trusting relationship and partnership with patients and their families,” he said.
That partnership determines whether patients speak up early, when symptoms are still subtle and treatable.
“Once we do that, patients are much more comfortable calling us when something doesn’t feel right,” he said. “If we know early enough, we can treat it aggressively and put them back on the right trajectory.”
Without that relationship, patients may call later, or not at all, and by then, the window to intervene may be gone.
Lessons for transplant programs nationwide
As heart transplant centers across the country work to elevate quality metrics and extend long-term survival, Dr. Soleimani believes Penn State’s approach is transferable, though it requires institutional commitment.
“Treat the patient as a whole, not just the heart,” he said.
The model is not built around a single surgical technique, but around systems: prevention-first care, seamless coordination across specialties and deep investment in patient and family partnership.
At its core, he said, the work is not about outperforming a benchmark.
“At the end of the day, this is about keeping families whole,” Dr. Soleimani said. “Getting fathers back to their families, mothers back to their children, grandchildren. That’s why we do this.”
The statistics place Penn State among the nation’s top performers. The deeper achievement is more enduring: a system designed not simply to replace hearts, but to return people to the lives waiting for them.
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