Please review this section in detail to learn more about what to expect before your heart transplant.
Step 1: Initial Assesment
Once our team reviews patient information, we invite eligible patients to the IHVI Transplant Center for further evaluation. Family members are strongly encouraged to attend.
During the assessment, patients meet with our transplant coordinator, transplant cardiologist and financial coordinator:
Discusses in detail the pros and cons of heart transplantation, which carries a significant mortality risk.
Reviews all medical history and cardiac function studies (obtained in advance), confirms the patient's underlying disease and its severity, ensures that all other potential therapies have been tried or considered, and determines if the patient is an appropriate heart transplant candidate.
Explains the patient's insurance benefits or lack thereof and provides guidance and structured financial planning for the patient and family.
Step 2: Comprehensive Workup
After passing the initial evaluation, potential transplant candidates proceed to a comprehensive workup during which they’ll meet with a transplant surgeon, social worker, infectious disease specialist, and psychiatrist and undergo some or all of the following tests:
- Left and right heart catheterization with thermodilution cardiac outputs
- Cardiopulmonary stress test
- Echocardiogram or MUGA scan
Infectious Disease Tests
- Disease Tests
- Serologies for CMV IgG, VZV Ig, EBV, HTLV, RPR, measles, HIV, Hep B, S Ag, HepB core Ab, Hep B AB, Hep C AB toxoplasmosis titers for heart-lung recipients only
- 24-hour creatine clearance, urinalysis
- Pap smear, mammogram in all females once a year
- Arterial dopplers for candidates with ischemic heart disease or diabetes over the age of 50
- Carotid doppler studies
- Sigmoidoscopy for patients over the age of 50
- Abdominal ultrasound
- Dental clearance
- CBC with differential
- PT/PTTfoghghgn gh. v
- Lipid panel as needed (LDL, HDL, cholesterol, and triglycerides)
- Thyroid function studies
- Stool for occult blood x 3
- PSA in all males over the age of 50
- Toxicology screen if indicated blood type, panel reactive antibody screen
- Hgb AIC/glycohemoglobin
- Pneumovax (if not previously received)
- Annual influenza vaccine
- Hepatitis B is not immune
- Varicella if not immune
- Tetanus every 10 years
Step 3: Collaborative Practice Committee
The multidisciplinary team that performed the evaluations meets for a collaborative review of the potential transplant candidate's case and workup.
Based on defined selection criteria, the committee will render one of the following five decisions:
- Accept the patient for transplantation
- Require further testing
- Defer listing the patient if they are too early, or there is a question about some aspect of the case such as compliance, psychosocial support, or nutritional status
- Recommend another form of therapy or procedure before listing
- Reject the patient for transplant
Step 4: Listing
Once accepted for transplantation and confirmed for insurance approval, patients are listed with the United Network for Organ Sharing (UNOS). This national computerized listing organization matches transplant recipients with available organs. Once placed on the UNOS transplant waiting list, a patient's name and medical profile enter a "pool." When a donor organ becomes available, the computerized system generates a list of matches.
Matches are based on the following criteria, and include:
- Locality (where the patient is listed)
- Time spent on the waiting list
- Blood type
- Physical size
- Severity of illness
Donated organs are always offered first to recipients waiting in the local community. If there is no suitable match in the local area, the organ is delivered regionally, then nationally.
The DC and Northern Virginia area organ procurement organization is the Washington Regional Transplant Community (WRTC). This organization is a vital link between the donor and recipient and is responsible for the recovery, preservation, and transportation of most organ transplants at Inova. WRTC also works with the local community and other hospitals on organ donation and awareness.
Step 5: Waiting Period
Transplant candidates accepted for listing must either have a pager or cellular telephone, so they are always accessible. It is the patient's responsibility to be available at all times.
Patients must inform the transplant coordinator when they are:
Sick or hospitalized
Going to be unreachable or unavailable
While awaiting transplant, patients see their transplant cardiologist, who may require the patient to be hospitalized, placed on intravenous medications, or implanted with a heart assist device to maintain stability until the candidate matches with a donor heart.
Step 6: Evaluation of the Donor Heart
All donor hearts undergo an evaluation by a cardiologist to ensure the best quality organ for each recipient. The evaluation includes a physical examination, echocardiogram, EKG, a heart catheterization (if indicated), and laboratory testing to evaluate for exposure to or presence of infectious diseases.
Ultimately, the transplant surgeon who procures the heart at the donor hospital decides whether it is suitable for donation. It is not uncommon for a heart that appears suitable by all parameters to have a problem only evident at the time of the surgical procurement.
With these potential pitfalls, it is not uncommon for heart transplant candidates to have one or more "dry runs," where they are admitted for transplantation, only to be discharged later because the donated heart is deemed unsuitable for transplantation. These experiences are an emotional roller coaster for patients and their families, and it is essential to be aware they are possible, even likely, during the period before transplantation.
Step 7: Transplantation and Recovery
Inova's transplant team works together to coordinate every facet of the transplant procedure, from organ procurement and the surgical procedure to patient and family support.
Once a compatible donor organ becomes available, we notify and admit the patient to Inova Fairfax Hospital, where they'll stay approximately two weeks post-transplant.
After surgery, patients go to our Cardiovascular Intensive Care Unit (CICU) and eventually transfer to a private room overseen by staff members experienced in caring for transplant patients.
Our transplant team teaches the transplant recipient what to expect during recovery, including information about the required immunosuppressive medications and how to monitor progress at home.