> What is cardiac transplant
> Tests to determine if you are a good candidate

Heart Transplant

When your heart can no longer be helped with medication, surgery or device therapy, your health care provider may decide that you should be considered for a heart transplant. University Hospital has the Tri-state’s only heart transplant program, which began in 1985. The program allows the patient to have a new chance at life. We sincerely believe that the care we provide to our heart transplant patients is second to none. Excellence is not only measured in clinical outcomes — how many patients in our program are transplanted and return to productive lifestyles — but also in the quality of life of our patients during the entire transplant process, from their evaluation as a transplant candidate, to their surgical care as a patient in the hospital and throughout their follow-up treatments as a transplant recipient. Specialized cardiologists and surgeons work together to correct abnormal, and potentially fatal, disturbances in the heart rhythm. Our cardiac surgeons assess and implement the newest option to ensure that surgery’s results are successful.

The surgeons and cardiologists of University Hospital have a long and distinguished history of advancing "standards of care" by using innovative surgical techniques, applying scientific research in immunosuppression to the clinical setting and inventing and perfecting life-sustaining assist devices. In particular, we participate in use of left ventricular assist devices (LVADs) that can either be used to prolong life while waiting for organ availability or as a destination therapy for patients who are not eligible for transplantation.

Transplant recipients are not passive participants in their health care; they must be proactive and influential activists during the entire process. It is critical that transplant recipients maintain their health while waiting for an organ, manage the physical challenges of surgery and its long recovery period, and return themselves to their family and work roles. They face many lifestyle changes, including unceasing monitoring of cardiac and total health, an extensive medication regimen, and committing to healthy habits in eating and physical exercise.

Our transplant team joins our patients in their lifelong commitment to returning to and maintaining sustained good health.

What is cardiac transplantation and when is it an appropriate treatment?
Organ transplants offer individuals facing serious disability and death the opportunity to lead more fully functioning lives. More than 19,000 organ transplants are performed in the United States each year. The kidney was the first organ to be successfully transplanted in humans. Today, transplantation is performed with kidneys, liver, the pancreas, lungs, the heart, intestines, bone marrow and bones, corneas, skin, saphenous veins and valves of the heart.

Cardiac transplantation is the surgical placement of a healthy heart from a human donor into the body of a person whose own heart is badly diseased. The procedure is also referred to as orthotopic cardiac graft.

A heart transplant is performed when congestive heart failure or heart injury can't be treated by any other medical or surgical means. It's reserved for those individuals with a high risk of dying from heart disease within one or two years. Most patients who undergo a transplant have one of two problems. One is irreversible damage to the heart caused by coronary artery disease, commonly called "hardening of the arteries," and multiple heart attacks. The other problem is cardiomyopathy, which is also known as heart muscle disease. In this condition, the heart cannot contract normally because of damage to the muscle cells. It may have been caused by bacterial or viral infection or hereditary factors. Occasionally, heart transplants are performed on people with other forms of heart disease. These might include the effects of rheumatic fever or hypertension (high blood pressure), abnormalities in the heart valves that cause damage to the heart muscle, congenital heart defects, those structural abnormalities present at birth or rare conditions like heart tumors.

Who is a candidate for cardiac transplantation?
With recent advances in surgical techniques and improved medical management of organ rejection after transplantation, an increasing number of those with end-stage cardiac disease are appropriate candidates for heart transplantation. The major limiting factor today is the short supply of donor organs.

In general, transplant candidates must be suffering from end-stage heart disease, but be in relatively good health otherwise. There are four basic questions that must be answered by the patient, his or her family and the evaluating physicians:

• Have all other treatment options been considered and tried or ruled out?
  
• Is the patient likely to die without benefit of a heart transplant?
  
• Is the patient in general good health without active infections nor other complicating illnesses?
  
• Will the patient be able and committed to assuming and maintaining the lifestyle changes that transplantation demands?
  
• The transplant team meets on a regular basis to discuss patients who have been evaluated for heart transplantation. A decision is made based on the evaluation and
  
• the recommendations of all of the transplant team members. If the patient is not a
  suitable candidate he/she will continue to be treated with the best medical management
  available.

Who is involved in the pre-heart transplant evaluation process?
Social worker/Psychiatrist: The social worker and/or psychiatrist will examine your emotional needs, concerns related to housing, medications and caregivers issues.

Nutritionist: This person will determine your ideal body weight and teach you about dietary restrictions. These may include low fat, low salt and fluid restrictions.

Financial counselor: This counselor reviews your insurance coverage and clears you for further testing. He/she provides information to you related to expected expenses, benefits you may have access to and the application process for such benefits.

Heart transplant surgeon: The surgeon evaluates your surgical and medical history to determine if heart transplantation can be performed from a surgical perspective.

Heart transplant cardiologist: He/she reviews your cardiac history and other disease processes.

What pre-heart transplant tests are necessary?
The transplant coordinator schedules testing that may include all or some of the
following:

• Chest x-ray
  
• Labs: blood and tissue typing, hepatitis and HIV testing, blood clotting tests, kidney
  and liver studies.
  
• Right heart catheterization
  
• Echocardiogram
  
• Pulmonary function testing
  
• Carotid and lower extremity doppler studies.
  
• Abdominal ultrasound
  
• Gastro-intestinal evaluation
  
• Mammogram and PAP smear (for females), prostate exam (for men)
  
• Complete dental exam