Background and Objective: Heart transplantation is the most effective treatment option for patients with end-stage and refractory heart failure. Despite many advances, there are still serious challenges in caring for these patients, and these patients face numerous complications, and caring for them requires specialized knowledge, skills, and experience. Therefore, the aim of this study is to conduct a narrative review of the existing literature in order to identify, classify, and analyze the challenges of nursing care in heart transplant patients.
Materials and Methods: this study is a narrative review with a structured search strategy. A search for sources without time limits was conducted in the databases Magiran, SID, IranDoc, and the external databases PubMed, Scopus, WOS, Ovid, and Embase. The search was conducted with keywords separately and in combination without time limits until the end of October 2025. The inclusion criteria included all articles published in Persian and English with full access to the text and content of the article.
Findings: The findings showed that in the clinical domain, infection prevention and management were the most common challenges, followed immediately by early diagnosis and management of transplant rejection; in the educational domain, education on treatment adherence and self-care was reported to be the most frequent challenge; in the psychological domain, burnout and secondary traumatic stress were the most prominent issues identified; in the organizational domain, the shortage of specialized nursing staff and the lack of team collaboration and coordination were the most important problems; and in the developmental and transitional domain, the transition of care from adolescents to adults was the main challenge, which carries the risk of non-compliance, reduced adherence, and increased likelihood of organ rejection.
Conclusion: The challenges of nursing care in heart transplant patients are multidimensional, interconnected, and go beyond technical issues and are considered a professional and human issue. Nurses struggle with severe burnout, high turnover, and a shortage of skilled personnel while simultaneously managing infection and transplant rejection, continuing education, emotional support, and team coordination. Overcoming these challenges is only possible by strengthening organizational support, regular screening of nurses' mental health, improving multidisciplinary collaboration, continuing education, and utilizing new technologies; otherwise, maintaining a skilled nursing workforce and providing quality care for these complex patients will be at risk.