Transplant Evaluation
You will either be admitted to the hospital for a few days to have certain tests done or be scheduled as an outpatient in the clinic to complete your evaluation. An evaluation will usually take four days to complete. These tests are to determine:
If you need a new heart.
If there is any other illness, infection, or problem that could make the transplant surgery too risky.
If you are both physically and emotionally strong enough to undergo a transplant.
These tests include:
Blood tests - You will have many tubes of blood drawn. We will check the function of your kidneys, liver, and immune system. We will also determine your blood type.
X-rays - You will have a chest x-ray, and possibly hip and spine x-rays.
Cardiac catheterization -a right heart catheterization will be done to check the pressures in the heart. After numbing the area, a catheter will be inserted into a vein in the neck and advanced into the right side of the heart. Pressures will be measured of the heart chambers, main blood vessels and valves.a left heart catheterization may be done to check for blockages in the arteries of the heart. A catheter will be inserted into a blood vessel in the groin and advanced to the left side of the heart. Dye will be injected to look at the arteries and the pumping action of the heart.Both of these procedures are done in the Cath Lab. Let the transplant team know if you are taking Coumadin (blood thinner), as you will be told to hold this medicine for a few days to prevent bleeding after the procedures. Also, tell the transplant team if you are allergic to shellfish, iodine, or contrast dye. If you have any of these allergies, you will need to take medicine to prevent any type of allergic reaction before the left heart catheterization.
MUGA Scan - This test shows the function of both the left and right sides of the heart. It will tell us how much blood it puts out every minute when you are not exercising (ejection fraction). It also checks for weaknesses (aneurysms) of the left ventricle and heart wall. During the test you will be given a special dye in your veins to help us get a better picture of your heart. You do not need medicines before this type of dye if you have an allergy. The entire procedure takes about 90 minutes.
Echocardiogram - This test is an ultrasound of your heart. It uses sound waves to check the size, shape and motion of the heart and its valves, the heart pumping function and can detect fluid in the sac around the heart (pericardial effusion). A gel is applied to the chest and a wand with a ball on the end will be placed on your chest and moved around to get pictures of the heart. EKG - This test checks your heart rhythm and checks to see if you have had a heart attack. It measures the electrical current of your heart.
Lung function test - This test tells us how well your lungs are working. You will breathe in and out of a hose that will measure how much air your lungs can hold.
Exercise stress treadmill test - For this test you will be hooked up to a breathing mask and EKG machine while exercising on a treadmill. This test gives us very important information about whether you are sick enough to need a transplant.
Abdominal Ultrasound - This test uses a wand and gel to look at the organs in the abdomen. You cannot eat or drink for 6 hours before the test. This test will usually be scheduled by 9am.
Bone Density Scan - This test will check your bones for osteoporosis (calcium loss in bones).
24 Hour Urine – You will be given a container to collect urine for 24 hours. This determines kidney function by measuring how well the kidneys are clearing wastes from the blood. You will be instructed to bring the container to the clinic at the beginning of your evaluation.
You may need other scans, such as MRI or CT scan of your head or chest, depending on your age and medical history.
Evaluation by other specialists – heart surgeon, psychiatrist, social worker, dentist, lung doctor, dietician. You will be seen by several of these specialists to help determine if a transplant is the right treatment for you.
Females will also need to see a gynecologist for an exam/Pap smear. A mammogram may also be indicated.
If you smoke you need to quit at least 3 months before you can be evaluated for a heart transplant. If you are found to be smoking after being listed for a heart transplant, YOU WILL BE REMOVED FROM THE LIST. Smoking increases your chances of getting pneumonia after surgery. It also increases your chances of developing blood clots, having trouble with your blood pressure, and can cause heart and lung problems, including cancer. You will need to continue not smoking after your transplant.
If you drink alcohol you need to stop at least 3 months before you can be evaluated for a heart transplant. You may also be required to attend an approved rehabilitation program, such as Alcoholics Anonymous. You need to avoid drinking alcohol after transplant as well. Alcohol does not mix with your medicines. You could get liver damage or develop rejection.
Remember that getting a new heart is not a cure for heart disease, it is only another type of treatment. You will need to make changes in your lifestyle, diet and activities, and commit to long term medical follow-up after your transplant. A transplant gives people a second chance. It is up to you to take care of your new heart. It is very important for you and your family to talk about the commitment to transplant and decide if it is what you want.
Once your transplant evaluation has been completed, your case will be presented at our weekly Transplant Selection Committee meeting. In this meeting, the results of all of your tests and consults will be discussed among the transplant team members. The decision about transplant will be talked over with you by the coordinator and/or physician.