The first step in the transplant process is evaluation. During the evaluation, you will meet many people, and undergo several diagnostic tests. These tests will help us decide if you are ready for heart transplantation, and if transplantation will help you. Sometimes a transplant could be risky for you owing to other health conditions.
During this process, you will meet the transplant team which includes the transplant surgeon, cardiologist, psychiatrist, transplant nurse, nutritionist, social worker, financial coordinator, physical therapist, and counsellor.
You may need to come in more than once to be evaluated by different specialists. Our team will guide you through the transplantation process while empowering you to decide if transplantation is the best way forward for you. After the medical evaluation, if the team has decided to recommend you for heart transplantation, it is your final decision whether you want to move ahead or not.
During the evaluation, you will have to go through the following tests. This is a combination of blood tests, and other specialised diagnostic examinations.
Laboratory Tests:
- HIV 1/HIV 2 plus O, EIA
- Hepatitis B/ C
- Quantitative Immunoglobulins
- Lipid profile
- Thyroid function tests
- Quantitative Immunoglobulins
- RPR
- CEA
- PSA (Male Patients only)
- CMP
- PT/INR; PTT
- EBV IgG+IgM
- CMV IgG+IgM
- Toxo IgG+IgM
- Cocci IgG+IgM
- Routine Urinalysis
- Urine Toxicology Screen
- Hemoglobin A1C
- Stool for Occult Blood
- Creatinine and Protein
- Quantiferon TB Gold
- Varicella IGG
Diagnostic Tests:
- Mammogram [Only for Female Patients]
- Pap Smear [Only for Female Patients]
- Electrocardiogram (ECG)
- Echocardiogram 2D with CF Doppler
- Colonoscopy (if age>50 and/or blood in stool)
- Bilateral Carotid Duplex
- Bilateral Lower Extremity ABI
- Bilateral Leg Vein DVT
- Gastric Emptying Study
- Right Heart Catheterization
- Nuclear Medicine Ventilation
- Right & Left Heart Catheterisation
- Full dental examination and clearance
- Ophthalmology consultation
- Bone Density Scan
- Diaphragm Nerve Conduction Study
- Esophageal Motility
- Esophageal Impedance Study
- Upper Gastrointestinal Endoscopy
Psychosocial Evaluation
Our social worker will work with you to help you understand the entire transplantation procedure, and prepare you, your caregiver, and your family for it. You will require a dedicated caregiver during and after transplantation who will be able to help you with your daily activities, medication schedule, and doctor consultations. You can talk to the social worker about any questions, concerns, or doubts that come up.
Psychiatric Evaluation
The stresses associated with waiting for a heart transplant and going through the process are immense. The psychiatrist in our team could help you deal with these stresses better. During the psychiatric evaluation, the doctor will also assess emotional problems, and alcohol or substance abuse issues in the past.
Dental Evaluation
Infections in the mouth could cause problems later after the surgery. We recommend that you work with a dentist to get a complete dental clearance during the evaluation.
Nutritional Evaluation
Our nutritionist/ dietician will work with you to help you change into a heart-healthy diet. This will help you stay in the best of health while waiting for a donor heart, and maintain the best of help after the transplant.
FINAL DECISION
The decision to place a patient on the waiting list is a multidisciplinary one. Following the completion of the testing, the patient is presented at the Heart Transplant Listing Meeting, which is held weekly. The patient and relatives will be informed of the outcome and a representative from the transplant team will discuss it with them.
The multidisciplinary transplant meeting comprises of a wide selection of healthcare professionals. The team includes:
- The Program Director
- Surgeons
- Pulmonologists
- Cardiologists
- Transplant Coordinators
- Transplant Nurses
- Dieticians
- Pharmacists
- Financial Counselors
- Social Workers
If the team and the patient decide to go forward with transplantation, he or she is then registered with the local OPO (Jeevandan, Transtan, ZCCK, NOTTO) and placed on the waiting list. If the patient is not deemed suitable and/or declines the option of transplantation, the medical team explains the alternatives to the patient, caregiver, and family members. We also inform the referring clinicians of the outcome of the assessment.