Before you are admitted to a heart transplant program, the transplant center will require you to go through a heart transplant evaluation. At Columbia Presbyterian, the evaluation took up the better part of three days. At Tampa General, the evaluation was quite different and also took three days.
The purpose for this evaluation is to determine the patient’s preset and projected success with transplantation. You will find that the center will receive information from your current physicians, but the center will not proceed until they have thoroughly examined all existing physical and psychological conditions.
One of the primary concerns is the existence of cancer. The reason for this is that the post-surgery medications conflict with cancer symptoms. As a result, the heart transplant patient will expect to take a colonoscopy. If the candidate has any history of cancer, the center is likely to be skeptical because the transplant medications increase the risk of cancer for every heart recipient.
Infection of any sort is a major concern for transplant candidates. The candidate should expect a series of blood draws. The patient will be asked to provide the results of a dental examination. If there are any issues, the center will require the candidate to comply with the recommendations the dentist has made. If the patient is on Warfarin or Cumadin, the patient will need to halt intake and move to lovenox injections until after the dental work.
After the dental work and colonoscopy, the patient will undergo a series of tests. Pulmonary hypertension is a condition that would put a stay on the transplant. Therefore, the candidate will take pulmonary stress tests. Depending on the outcome, the pulmonary condition can be treated with prescription drugs like nitroprusside, nesiride, dobutamine or similar medications.
The candidate’s age used to be much more of a concern than it is now. Age limits used to be between 55 and 60. With great prescription therapies, candidates up to age 70 are receiving hearts. Transplant Centers have begun to regard the physiological age of the candidate as a more important factor. Therefore, other body organs like the liver, the kidneys, the gall bladder, the spleen and the lungs will come under close scrutiny.
Once admitted to the program and during recovery, the medications become much, much more powerful. These medications take a toll. One pre-transplant medicine, Lasix, is used to reduce the fluids in the body. Unfortunately, Lasix is prone to take a toll on the kidneys. Warfarin or Cumadin are also troublesome. The candidate will need to have blood tests on a very regular basis. Warfarin thins the blood. This improves circulation. But, the patient becomes very vulnerable to internal bleeding and external bruising. The slightest scratch can create surprisingly flow of blood. As for me, the slightest bump or scratch gets an immediate reaction. Bumps can become external openings and they are slow to heal.
Diabetes is a real concern for transplant recipients. Persons with diabetes not related to complications with the kidneys, retina or nervous system can receive heart transplants and have had success equal to recipients without diabetes.
Lung disease will be negatively impacted post surgery. Similarly, candidates with a pulmonary embolism will b treated with Warfarin and not accepted as a viable candidate until the embolism is dissolved.
Here is a list of other limiting complications:
- Advanced liver disease
- Renal insufficiency
- Advanced peripheral vascular disease
- Severe obesity
- Advanced cardiac cirrhosis
- Active peptic ulcer disease
In my own case, on a recent hospital stay, I was diagnosed with gallstones. They were removed with orthoscopic surgery. The physicians were astounded to find that the gall bladder had 23 stones. The physician gave me a photo of the stones. He thought it might be a world record.
The heart transplant evaluation will include a meeting with a neurologist, who will ascertain your cognitive powers After a few embarrassing memory tests, you are likely to be unnerved. Not to fear. When it comes to heart transplantation, some dimness is not all bad.
A sociologist will discuss any needs but specifically will review your support system. You will be expected to have a number of support persons that can assist you during the wait and recovery. The sociologist will make a list of the helpers and their contact information. A social worker can also work with the candidate to make certain that all insurance options have been researched.
Another aspect of the pre-transplant evaluation will be a meeting with the center’s financial services department. They will verify your coverage and advise you of all potential liabilities.
The center will have a psychiatrist or a psychologist on staff. The candidate will meet with this individual and undergo an informal mental wellness discussion. In my experience, I did not really pay much attention to this part of the testing. At both of the centers I listed, these persons played an integral part of the wait and recovery. These stages are filled with a certain amount of anxiety and I found the advice from here was comforting. Chances are good that these practitioners have seen and heard it all. Sometimes you just have to let it fly.
After all the testing is done, you will meet with a coordinator and the cardiologist. When your new heart comes available, the coordinator will contact you. After these meetings, your case will be reviewed in detail with a board from the center that will jointly determine if you are a good candidate. You will get a quick response about your candidacy.
If you are accepted for heart transplantation, you will be issued a manual from the center explaining their procedures for every stage of the process. I cannot stress too much how important it is to read and digest every sentence in that guide. It is also strongly recommended that your support team read the center’s heart transplantation manual. Good luck. Chances are good that you will have a good outcome but the time to prepare is now.