In general, patients with advance heart failure, or on maximal medical therapy, should be considered for transplant evaluation. Patients with increasing medication requirements, frequent hospitalizations, or overall deterioration of clinical status should be referred for evaluation. Some causes of heart failure that result in cardiac transplantation are primary cardiomyopathy, coronary artery disease, with either resultant ischemic cardiomyopathy and symptoms of congestive heart failure or inoperable ischemic heart disease with refractory chest discomfort or arrhythmia. A small percentage of patients who undergo cardiac transplantation do so for idiopathic dialated cardiomyopathy, valvular heart disease, congenital heart disease and inoperable hypertrophic cardiomyopathy.
All candidates for transplantation enter the program with a comprehensive series of tests conducted by our multidisciplinary team of specialists. Some of these tests are required for any operative procedure (history and physical chest x-ray EKG etc.) while others (such as specific blood tests) are required for transplantation surgery.
Once the evaluation is complete, the transplant team will recommend treatment options and discuss if heart transplant is the best option. The risks and benefits will be discussed with each patient. After a candidate is accepted for transplantation, the patient is then placed on the national transplant waiting list maintained by the United Network for Organ Sharing (UNOS). Depending on the blood group, the average waiting time on our list is currently less than 12 months. The time may be shorter or longer depending on the donor supply and the patient waiting list. While waiting, the patient is followed in the office periodically to assist with any medical issues that may arise.
The TCI Heartmate Left Ventricle Assist Device is a mechanical circulatory support system and can serve as a bridge to transplantation. The use of the Heartmate including enhanced intra-operative technique allows patients to be in better condition for transplantation.
A Network of Support
During the initial stages of evaluation, the patient undergoes many tests and sees many specialists. This is also the time when the patient is first introduced to the support network. The transplant coordinators, social worker, and Financial Coordinator play an extremely important role in providing this support.
The Transplant Coordinators are involved in the pre-transplant screening and stay involved throughout the years of follow-up care. In this way, patients benefit from having the same people throughout their participation in the program. Our patients tell us that the transplant coordinators, because of the range of their involvement and the depth of their concern, are essential participants in the support network.
Our social worker is a resource, advocate and a link between patients and all the services designed to assist them. The social worker helps patients and their families address the many complex social and personal that arise for transplant patients. The services range from helping with personal and psychological issues that result from living with a chronic medical condition, to lodging, joining support groups and receiving vocational rehabilitation.
The Financial Coordinator assists patients with financial and insurance issues related to transplantation. The services include assessing patient insurance for hospital and pharmacy benefits, identifying and attempting to resolve patient financial problems, and helping patients in requesting and applying for assistance from transplant resource programs.
In addition, there are Support Groups available.