Transplant Center

To be considered as a candidate for a heart transplant, you will first undergo a thorough transplant evaluation. The evaluation will help our transplant team learn more about you and your disease, and provide you with the opportunity to learn more about our heart transplant team and transplant program.

During the evaluation, you will go through a series of tests and consultations. The transplant physicians will be looking for medical and/or emotional conditions which would affect the chances for a successful transplant. Most evaluations are completed while you are in the hospital, but there may be some circumstances when you will be required to undergo some tests after being discharged.

Before a person can be put on a waiting list for a heart transplant, the determination has to be made that there is no other treatment option available for the patient's condition. In addition, it must be determined that you are physically and mentally capable, and your family/support system are also capable, of enduring the transplant process.

You will meet with a transplant coordinator, transplant surgeon, transplant cardiologist, psychologist, social worker, transplant financial counselor and psychiatrist or psychologist during the transplant evaluation. These visits or appointments will help us find out if there are special concerns that you and your family may have in regard to the transplant and what type of support is needed for a successful transplant outcome.

Evaluation Process

You will be asked to sign an Evaluation Consent Form prior to starting the transplant evaluation.  A nurse coordinator will review this consent form with you and answer any questions you might have at this time and as the evaluation process moves forward.  You might find it convenient to start a notebook or journal of your questions and write them down as you think of them so you do not forget them.  Later, when you ask your team, you can also write down the answer provided.

Depending on your medical history, there may be additional physician visits and tests required. However, most evaluations will include:

• Blood testing (including hepatitis, kidney function, liver function, syphilis, chickenpox, and HIV)
• Blood and tissue typing (because of the body's immune system, any tissue or organ introduced into a human body that is not a part of that body will cause a natural process to start that will ultimately damage or destroy the foreign tissue or organ; thus, a potential organ recipient must have blood and tissue-typing tests done so that a donor organ that most closely matches the recipient can be found)
• You may also have a drug or tobacco screen done
• Heart studies, which may include any or all of the following;
• Echocardiogram (to assess the heart's valves and mechanical pumping function)
• Electrocardiogram, also called EKG (to assess the heart's electrical conduction system)
• Holter monitor (to assess the heart's electrical conduction system in more detail than a regular EKG)
• Right heart catheterization (to assess the pressures inside the heart, which helps your physician determine your heart's functioning capability)
• Left heart catheterization (to look at your coronary arteries)
• Cardiopulmonary stress test (to look at your heart and lung function together, and to check your oxygen demands during exercise)
• Pulmonary function tests (to evaluate lung function and capacity)
• Urinary system evaluation, which includes a 24 hour urine specimen (to evaluate kidney function) and possibly kidney ultrasound (which checks for renal artery stenosis, a narrowing of the blood vessels to the kidneys, which could lead to high blood pressure)
• Abdominal ultrasound (to assess for gallstones and/or other abdominal conditions or diseases)
• Skin Tests, including a skin TB test
• Chest x-ray (to assess for lung infection, other pulmonary diseases, and heart size)
• Carotid duplex and peripheral vascular Doppler studies (sound wave test of the arteries in your neck and legs)
• Dental exam, including a panorex, a special type of x-ray of the teeth and jaws (to assess teeth for cavities and abscesses that might cause infection after transplant; your dentist will be required to clear you for a transplant)
• Complete physical exam

While the tests and procedures are in progress, the nurse coordinator will contact you on a regular basis to keep you informed of the results. You may be discharged from the hospital before all the results are available, and some of the testing may be done on an outpatient basis. If you have outpatient testing scheduled, it is important to arrive on time. Please keep in mind, however, your procedure may not begin immediately when scheduled. This could be due to varying lengths of procedures scheduled before you. You will be updated as frequently as possible.

Financial Evaluation

The Financial Counselor will meet with you as a part of your evaluation, and is available at all times to answer any questions you might have. You will also meet with a Pharmacy Financial Counselor to discuss your insurance coverage and benefits, inform you of the potential medications and their costs, and answer any questions or concerns you and your family may have.

The Financial Counselor and Pharmacy Financial Counselor will help you understand the financial considerations associated with a transplant.

Family Situation

A meeting with a social worker will be set to help establish that potential heart recipients have an adequate and stable support system.

Psychological Evaluation

You will meet with either a psychologist or psychiatrist who will complete an evaluation. This is done to assist in determining whether a potential heart recipient will be able to comply with the necessary treatment regimen before and after transplant.

When all evaluation processes are completed, your case will be reviewed by the transplant team during the transplant selection meeting to determine if transplantation is an option of treatment for you. The transplant team will review the results of all tests and carefully consider all factors before a final decision is made. The nurse coordinator or cardiologist will notify you following the selection meeting and the cardiologist will correspond with your primary care physician.

Listing Decision

When the team makes a decision to put you on the transplant list, you will be notified in writing of the team's decision. If the team determines transplantation is an option of treatment for you and decides to place you on that list you will be asked to sign a Listing Consent Form.

Listing on the heart transplant list is based on medical urgency, with 3 main classifications:

• Status 1A: Status 1A is the most urgent; these people are in the hospital with mechanical support and multiple IV medications, with usually less than 1 week left to live in the opinion of the medical staff.
• Status 1B: Status 1B is slightly less urgent; these people could also possibly be at home with a Left Ventricular Assist Device.
• Status 2: The least urgent status is Status 2. These patients are the healthiest.

Your status can vary based on your health, and will be followed closely by the transplant team. For more information on these statuses and the wait list, you can visit www.unos.org or ask your Transplant Coordinator.