[Return to work after heart transplantation].

Heart transplantation is the most effective treatment option for patients with end-stage heart failure to improve exercise tolerance and quality of life. This increase in quality of life may assume that heart transplant recipients are also able to return to their work. In general, there are no medical reasons to oppose a return to work. Despite enormous advances in medical rehabilitation after heart transplantation, the rate of working people among heart transplant recipients is very low. According to a survey at the Heidelberg Heart Transplant Center, only 37% of the heart transplant recipients return to work. This may be caused by tranplant-related problems as well as factors independent of heart transplantation. Furthermore, the psychological burden due to heart transplantation might hamper professional rehabilitation. Thus, psychotherapeutical support during transplant process appears to be appropriate. As a major issue for a return to work appears to be the patient's will, the voluntary nature of return to work step by step has to be limited. Programmes with close collaboration between physicians, health insurance companies, retirement insurance companies, employers, and especially the patients are necessary to increase the rate of professional rehabilitation and to underscore the health economic justification of heart transplant programmes.