Heart transplant program process

Yes, it's important for you to bring someone to the evaluation visits to act as your main support person. This person should be someone who will help you before and potentially after your transplant.

The support person can:

• Help ask questions
• Provide additional health information
• Offer emotional support
• Help recall information discussed at the visit

For each outpatient visit, please remember to bring:

• State ID or driver’s license
• Insurance card
• Current medication list
• Any medical records or written information regarding past medical history
• Name of referring physician, and their address and phone number
• List of questions
• Referral for the office visit (HMO members)

The initial visit can take up to two hours. Most of this time is spent:

• Reviewing your health history
• Providing education about the risks, benefits and expectations of heart transplantation
• Addressing all questions

Our team strongly encourages you and the people accompanying you to eat a full meal prior to your appointment.

First, you will meet a transplant cardiologist, a surgeon and an advanced practice nurse. The team will review your medical history and current health status thoroughly. If they determine that you would benefit from transplantation your case will move forward toward a full transplant evaluation.

The full transplant evaluation consists of:

• Consultation with our transplant and multidisciplinary team
• Extensive cardiac testing
• Imaging
• Laboratory tests
• Cancer screening

You may be seen by specialists from the multidisciplinary team to address any other organ-specific issues discovered during the initial or full transplant evaluations. Depending on your current health status, testing is performed either on an inpatient or outpatient basis. The advanced practice nurses will arrange the testing ordered by the physicians.

As part of our weekly transplant team meeting, patients undergoing evaluation are presented to the multidisciplinary team to determine candidacy and treatment recommendations based on the following:

• Results of diagnostic tests
• Medical criteria
• Fitness to undergo surgery
• Chance of recovery
• Various lifestyle factors

After being deemed eligible for transplant, you will meet with the transplant coordinators to learn about the transplant process and consent for listing. You are then placed on the national organ transplant waitlist through the United Network of Organ Sharing (UNOS). While on the waitlist, monthly blood work and check-ups are performed to monitor your condition.

Once a donor is identified and deemed suitable for organ donation, UNOS will run a match list to identify those patients eligible to receive organs from this donor. A cadaveric heart is matched to a patient based on:

• Blood type
• Height
• Weight
• Distance
• Time on the UNOS waitlist
• Medical urgency

When a match is found, the transplant team will call you and surgery will occur immediately. Once admitted, you will undergo some minor lab work and a physical exam, and then will be moved to the operating room. The transplant requires two surgical teams. One team will be in place to retrieve the donor heart while the other surgical team first prepares for and then performs your surgery. Even though the actual suturing of the heart can be completed within an hour, the entire transplant surgery can last six hours or more due to multiple factors such as:

• Distance from the donor hospital
• Scar tissue or adhesions from previous cardiothoracic surgeries
• Bleeding

Heart recipients will recover in our state-of-the-art Adult Surgical Heart Unit (ASHU), an intensive care unit designed specifically for open heart surgery patients. Depending on your status going into the transplant procedure, a post-operative stay is approximately 14 days. Specially trained nurses administer immunosuppressant drugs to help prevent your immune system from rejecting the transplanted heart. Before leaving the hospital, the advanced practice nurse, dietician and clinical pharmacist will teach you about:

• Caring for your incisions
• Recognizing symptoms of rejection and infection
• Understanding medications
• Activity guidelines

Upon discharge, you will follow up with members of the transplant team to monitor your progress as you resume normal activities. The follow-up visits are frequent immediately following surgery, but will decrease over time. The transplant team will work closely with your referring physician and primary care physician to ensure your care is coordinated and thorough.