Heart Pre Transplant
There are several phases of the transplant process. The first phase is considered the pre-transplant evaluation phase. This phase is an extensive pre-evaluation process in which providers and transplant nurse coordinators review your medical information, a patient access services staff person reviews your insurance benefits, and a financial counselor reviews your ability to afford all of the costs associated with transplantation. Your insurance company will need to go over your case and give authorization for the costs associated with transplant. Many forms and tests need to be completed before you can be added to the heart transplant waitlist.
Once we receive authorization from your insurance company and hospital administration, and it has been determined you are medically acceptable, you will move to the next phase.
Your transplant evaluation is usually done on an outpatient basis unless you are critically ill and require hospitalization. You will receive education about transplantation and have the opportunity to ask questions. During the evaluation, you will have appointments with many specialists in addition to members of the heart transplant team. You will also have lab work and diagnostic tests performed. The tests vary for each person.
During the evaluation you may be considered for alternative therapies, including VAD.
Selection process and waitlist
After all the testing and appointments have been completed, your case is presented at our team's Heart Committee Review Meeting which is held once a week. Members of the heart transplant team are present and your case is discussed. It will be decided if you meet all the criteria to be a heart transplant candidate.
The Heart Committee Review team may require additional testing or requirements to be met before you can be put on the heart transplant waitlist. Once all of the recommendations from the team are completed and you are an acceptable candidate, you will be placed on the heart transplant waiting list.
Heart Transplant Surgery
Once you have been called in for your heart transplant surgery, it is important for you to have this day planned out ahead of time. How will you get to the hospital? Where do you go? What do you bring?
When you get the call for your transplant, you need to arrive at Admitting on the 9th floor of OHSU. You will then go to a pre-op floor where the nurses and doctors will prepare you for the surgery. The time before the surgery is very busy. A resident, intern, or physician assistant will perform a physical examination and take a complete history. You will need to bring a complete list of all your medications. At this time you will be asked to sign one or more consent forms giving your permission to the surgeons to perform the surgery.
The nurses will start an intravenous line (IV) for antibiotics to prevent infection. When it is time, the nurses will take you to the operating room. Once you are placed under anesthesia, the transplant team goes to work. The average length of time for a heart transplant is 5-6 hours depending on previous heart surgery or if you have a left ventricular assist device in place. The length of time does not predict the success of the surgery. When the surgery is complete, the surgeons close your incision. After the incision is closed and you are stable, you will be taken back to the CVICU (Cardiovascular Intensive Care Unit).
While you are in surgery, your family and friends can wait in the intensive care waiting area. The operating room nurses may come out during the surgery to give a progress report. It's helpful to identify one spokesperson when communicating to the nursing staff, who will then pass along information to family and friends.
Cardiovascular Intensive Care Unit (CVICU)
You will wake up from the transplant operation in the Cardiovascular Intensive Care Unit (CVICU). The sights and sounds may seem strange to you. You will be attached to many tubes, IV lines, and monitors. The average length of stay in the CVICU is 6 days. This will vary depending on how you respond to the surgery, how quickly you recover from the anesthetic and how sick you were prior to the transplant. When you wake up you may experience some confusion due to the anesthetic. When you are stable you will be transferred to the Transplant Unit.
The Transplant Unit
The average length of stay on the Transplant Unit is nine days. This makes your total hospitalization stay approximately 16 days. This varies depending on your overall post-transplant recovery course. After your surgery, you may feel many different emotions. Many people feel relief that it is over. It is not uncommon to feel depressed or anxious after the surgery. All these emotions are common and most people feel a little of each.
While you are on the Transplant Unit you have some important responsibilities before you can be discharged, including eating, walking, coughing and deep breathing.
The transplant team will discharge you when:
- You are physically stable
- You know your medications and can set up each dose
- You know your clinic and lab schedule
- You pass the discharge review worksheet (reviewed by the coordinators)
You and your support person will learn all about your new heart, how to take care of it, how to prevent infection, your medications and your clinic and lab schedule. The coordinators, nutritionists, pharmacists and nurses will teach you how to take care of yourself now that you have your new heart. You will have received a heart transplant manual. This is your lifelong guide that you will need to continue to refer to. The transplant team expects you and your social support participate in your education during your hospital stay. The transplant coordinator and the pharmacist will come to your room to answer questions and review your medications. Prior to your discharge, you and your support will need to complete a worksheet on the information you learned.
Caring for Yourself After a Heart Transplant
You are the most important member of your care team. You need to be actively involved in your care by attending clinic appointments, getting your labs drawn, communicating with members of your care team and understanding how to take care of your new heart.
To help care for your heart, you will need to:
- Take medications as directed, and ask your doctor before taking any other medications, including over-the-counter medications and dietary supplements
- Eat a heart-healthy diet, avoid alcohol and do not smoke
- Contact your doctor if you are feeling ill, and avoid anyone with colds or infections
- Have your labs drawn as directed by your doctor, including any additional testing
- Follow lifting, walking, showering and activity restrictions
You will be given permission to drive approximately six-to-eight weeks following your transplant.
Monitoring Vital Signs
You will be asked to measure your:
- Blood pressure
Resources and Support for Heart Transplant
Transplantation can be stressful. We hope you and your family find the list of resources and support information helpful. The organizations and resources listed below may help you learn more about transplantation.
- Donate Life Northwest
- United Network for Organ Sharing (UNOS)
- American Thoracic Society
- Needy Meds
- National Association of Boards of Pharmacy
- American Heart Association - Heart Transplant
- HelpHopeLive (formerly National Transplant Assistance Fund)
- American Society of Transplantation
- International Society for Heart and Lung Transplantation