Before Heart Transplant Surgery

Before Surgery: Are You a Good Candidate for a Heart Transplant?

Before you can have a heart transplant, a team of healthcare professionals will want you to think about what is likely to happen if you do get a new heart. This depends on your physical health, your mental health, and your ability to get the transplant medicines you will need.

Below are the processes that determine how long this evaluation and preparation phase can take.

Visiting a Transplant Center

This visit can be arranged by your doctor, a nurse, or a social worker. You can also make the appointment on your own. Your doctor or his staff will be asked to send your medical records to the transplant center to make sure you currently do the following:

• take your medicine properly
• have no medical conditions that will prevent you from receiving a transplant

More information: Finding Out if You Are Sick Enough to Need a Heart Transplant

Having Your Physical and Mental Health Evaluated

Evaluating Your Physical Health

At the transplant visit, you will have a very thorough evaluation of your medical condition by transplant team members. The transplant team may require further testing to evaluate the following:

• your heart
• your kidneys and gallbladder
• your stomach, esophagus, and intestines
• your lungs
• your bladder
• your teeth and gums
• your prostate if you are a man
• your breasts and cervix if you are a woman

There may be other tests and examinations that the transplant team may need to perform.

Evaluating Your Mental Health

You may need to see a social worker or psychologist to make sure that you do not have the following:

• alcohol or drug addiction
• emotional problems that may interfere with your health

More information: Evaluation Period

You Will See an Insurance Specialist

You will see an insurance specialist to evaluate your insurance to make sure you have enough coverage for medication after transplant. Once it is determined that you are a good candidate for transplantation (healthy patient), the transplant team will work with you to find the best transplant for you.

Finding Out if You Are Sick Enough to Need a Heart Transplant

Because many heart diseases worsen slowly or respond to different therapies, the transplant center may wish to review your treatment options. They will want to determine if you have had the best possible therapy for your condition. Sometimes a new medication or therapy can make a big difference to how you feel and to the worsening of your heart disease. The transplant center does its best to make sure that you have had every chance to get better and live longer with your own heart before they will recommend that you have a heart transplant.

Evaluation Period

General Information

You will be seen as an outpatient or possibly be admitted to USC University Hospital for an evaluation because your doctor feels that transplantation might be beneficial to you. The purpose of our evaluation is to determine whether transplantation would be your best option.

During your evaluation, you will meet many people, have many blood and skin tests, x-rays, and other diagnostic procedures. These tests will help us to determine if transplantation would help you. Once in a while, we discover something that would make transplantation too dangerous for you. This could be an infection somewhere in your body, high blood pressure in your lungs, or severe thickening of your arteries.

People you will meet during your evaluation will include the Transplant Coordinator, Cardiologist/Pulmonologist, Social Worker, and Financial Counselor. In addition to these team members, you may also meet with the neurologist, psychiatrist, physical therapist and/or other specialist. The transplant coordinator will coordinate your care and will be available to answer any questions you may have. You will meet with physicians to help determine your medical suitability for transplantation. The information gathered about you from all of the tests and from each team member will help us decide if transplantation is the best treatment for you.

The evaluation period is designed not only for the team to learn about you, but also for you and your family to meet us, learn about transplantation and what our program has to offer you and your family. It will also give you the opportunity to learn about life with a transplanted organ(s) and most important, to decide if you wish to pursue transplantation at USC University Hospital. If you are accepted for transplantation, please remember that the final decision to have a transplant is yours, and yours alone. The commitment required to do well following transplantation is intense and the regimen must be adhered to.

Medical Evaluation

During your evaluation one or more of the transplant team members who will take your complete history will see you. You will be given a physical examination that will include laboratory and diagnostic testing in order to determine your eligibility for transplantation. These tests may be performed at USC University Hospital or at a local hospital in conjunction with your primary physician.

Social Service Evaluation

The social worker will meet with you and your family to identify support systems, your feelings about your illness and the possibility of transplantation. The social worker will also be able to assist you with your relocation needs, while in the Los Angeles area. There are many resources available, both within and outside the hospital that the social worker will be able to share with you.

The purpose of the group is to give you the chance to meet other transplant candidates and recipients, to address social issues that surround transplantation and to increase your knowledge about transplantation. Issues often discussed are: coping with waiting for transplantation, fear of the operation itself and insurance issues. Sometimes transplant team members will come to the group to talk about the transplant, medications, and anything else of interest to the group. There is usually a question and answer session afterwards. Patients and family members who come to the group find it to be supportive and informative. There is no fee for attending the group meetings.

Neurological Evaluation

You may need to go see the team neurologist who will examine you and discuss any past or present neurological problems that might have an effect on you after transplantation. Neurological tests will be done as indicated by your condition and as deemed medically necessary by the neurologist.

Psychiatric Evaluation

This evaluation provides us with an understanding of you and how you cope in your family life and under stress. The psychiatrist will assist you and your family in dealing with the stresses of a chronic disease. If you are chosen for a transplant, the psychiatrist will help you with the stresses of the waiting period and transplant process.

Physical Therapy Evaluation

Because exercise is vital to your well being after a transplant, exercise will become an important part of your life after transplantation. The physical therapist will meet with you to evaluate your current physical condition and limitations, given the severity of your disease. He/She will also be interested in the types of physical activity, if any, you enjoyed and took part in before you had health problems. Your joint motion, muscle strength, and condition will be evaluated to make sure there is no physical problems that will affect your participation in an exercise program after transplant surgery. Also, the physical therapist will teach you energy saving methods to help you conserve energy while waiting for a donor.

Dental Evaluation

Some patients may have an examination, consultation, and/or x-rays of their teeth during the evaluation period. Patients may be cleared through their private dentist. This is done to rule out any sources of hidden or potential infection in your mouth since infections of the mouth can be very troublesome if they occur after transplantation. The dentist will make recommendations for any treatment that you may need. You may have any necessary work performed by our private dentist.

Preoperative Preparation and Teaching

Even though the waiting period can be long and you have plenty of time to anticipate surgery, most patients say they are never fully prepared when the day really comes. Most of the time, you are rushing to get to the hospital and rushing to get prepped for surgery so there is not even time for last minute mental preparation.

Because we realize that there is not a lot of time when your organ does becomes available, we have included this section on what you can expect before you go to surgery and when you wake up after surgery.

Patient and Family Education Classes

In order to help you learn what you need to know, we offer a series of classes on the essentials of transplantation. These classes take place in the USC University Hospital.

The classes are given in a lecture and open discussion format. This gives you and your family members a chance to ask questions and anything you do not understand; and it gives us a chance to reinforce our teaching. We encourage all patients and interested family members to attend each class in the series at least once. You are welcome to attend while you are a patient in the hospital and after you are discharged from the hospital.

Waiting List

If you are accepted into the transplant program, a member of the team will notify you, and you will be placed on the waiting list. Your position on the list is based on your height or weight, blood type, time on the list, and for heart recipients the severity of your illness. The length of the list varies and may change daily.

Waiting Period

Waiting for a suitable donor to become available may take one week to a couple of years. Many patients and their families have described this time as the most difficult part of the transplant process. Denial, fear, anxiety, and uncertainty are normal reactions experienced by patients and their families. Because this can be a frustrating and difficult time, we encourage you and your family to attend the family support group sessions to help you with this process.

During the waiting period, you may experience one or more hospital admissions to help control your disease. Please notify the transplant office of any change in your condition, hospitalizations, change of address and/or telephone number. Even if you do not need to be hospitalized, you should continue visiting your local doctor regularly. In addition, we ask that you visit the transplant clinic periodically so that we may monitor your condition.

Living Arrangements

After you have a transplant, you may have to remain close to the transplant clinic for a few months because of your medical care needs. Although complications can occur at any time, the first three months following transplantation are the most crucial. Patients are seen weekly in the transplant clinic for the first month after discharge. Because of this need for frequent monitoring, some patients who live more than 65 miles from USC University Hospital may have to take up temporary residence in this area. The social worker will be able to assist you in finding a place to live in the Los Angeles area. If you are accepted to the program, please discuss your housing needs with the social worker as early as possible.

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Source: USC Cardiothoracic Surgery

Important Notice: HeartPatients.com does not provide medical advice, diagnosis or treatment. The information provided on this site is intended for your general knowledge only and is not a substitute for professional medical advice or treatment for specific medical conditions. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider. Please consult your healthcare provider with any questions or concerns you may have regarding your condition.

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