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Evaluation for Heart Transplantation

The most common conditions leading to heart transplantation are coronary artery disease coupled with multiple heart attacks, and cardiomyopathy, a disease of the heart muscle. Heart transplantation may be considered when patients develop end-stage heart disease as a result of these conditions, have no other medical or surgical options, and have a high risk of dying from heart disease within one or two years.

Ultrasound of the heart showing left ventricular hypertrophy
Ultrasound of the heart (axial section) showing left
ventricular hypertrophy. (photo: ISM/Phototake)

Evaluating physicians consider the following questions to determine a patient's eligibility for heart transplantation:

  • Have all other treatment options been ruled out?
  • Is the patient likely to die without the benefit of a heart transplant?
  • Is the patient in good health otherwise, without active infections or other complicating illnesses?
  • Will the patient be able and willing to maintain the lifestyle changes that transplantation requires?

During the evaluation process, candidates undergo many tests. These include:

  • blood tests
  • skin tests
  • x-rays
  • thorough dental exams
  • psychiatric evaluation
  • and neurologic tests.

If the transplant team determines that transplantation is a viable option, the patient is placed on the wait list for a donor organ.

Left Ventricular Assist Device (LVAD)

Some patients eligible for transplantation may also be candidates for a left ventricular assist device (LVAD), an implantable device that takes over the function of the heart's left ventricle. LVADs are often used for a period of time to sustain patients until the time of heart transplantation, known as bridge-to-transplantation. On average, patients use an LVAD for four to six months prior to transplantation. During this time the device allows their hearts to rest, heal, and grow stronger.

If a patient is not eligible for transplantation due to age, other health problems, or complications, and medical therapy is no longer effective, surgeons may implant an LVAD indefinitely. This is known as "destination therapy."

Dealing with Uncertainty

Waiting for a suitable donor heart may take many months. Transplant recipients and their families often describe this waiting period as the most difficult part of the entire transplant process. Because fear and anxiety are normal reactions during this period of uncertainty, doctors here often suggest that transplant candidates and their families attend support groups and avail themselves of the many support services available at the Hospital. These resources are available to assist patients and their families with the multi-faceted challenges associated with the organ transplantation process, and are helpful in providing encouragement, confidence, support, and practical information.

While You Wait
  • Stay in good health. When a donor organ becomes available the patient should be in the best possible physical condition. Good health makes it more likely that transplant surgery can proceed and that the patient will recover quickly after the transplant.
  • Stay in close touch with the team. Keep the transplant team's phone numbers accessible at all times, contact the team if any new health issues develop, and be sure to have regular checkups with the transplant team.
  • Be accessible at all times. When a donor heart becomes available the hospital must respond immediately. If a patient is unavailable or unable to have the transplant (due to infection, for instance) the organ may be offered to the next person on the wait list. Carry a beeper or cell phone so that you can be reached at any time.
  • Be ready to go. Have a transportation plan so that when a donor organ becomes available you are able to quickly and easily travel to the hospital.
  • Learn what to expect. While waiting for surgery patients should learn about the recovery process and about the medications they will need to take after surgery.
  • Plan ahead. Prepare an advance directive, a document that allows you to designate someone to make health-care decisions for you in the event that you cannot communicate yourself. Stipulate your wishes about the use of life-sustaining procedures and treatments.

Contact

NewYork-Presbyterian/
Columbia
Heart Failure and Transplantation Program
Directions
(212) 305-7600
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