Heart Transplant Evaluation Process

Qualifying for a Heart Transplant

To be considered for a heart transplant, patients must meet specific criteria to be added to the heart transplant waitlist. 

Who is Qualified for a Heart Transplant?

Typically, to qualify for a heart transplant, a patient must:

• Be diagnosed with advanced heart failure
• Be relatively healthy aside from their heart condition
• Have no history of substance abuse
• Meet certain BMI and age requirements

Factors Influencing Eligibility

Eligibility may be influenced by:

• The patient’s ability to support a new heart
• The support system from family or loved ones to assist in care

Age Considerations

Heart transplants can be performed at any age, from newborns to adults. For patients under 18, pediatric cardiology services are available. Additional factors are considered for patients over 70.

Heart Condition

Patients must be diagnosed with end-stage heart failure and undergo a heart evaluation. If approved, they are placed on the heart transplant waiting list until a donor heart becomes available. For those who do not qualify, options like artificial hearts or mechanical circulatory support devices (MCS) may be explored.

Overall Health

Candidates must be generally healthy aside from their heart condition and must refrain from drinking or smoking. Commitment to the transplant process, including evaluation, surgery, recovery, and lifelong care, is essential.

The Heart Transplant Evaluation Process

The evaluation process is thorough and can take between 2-3 days with an inpatient stay. It involves several steps:

Referral

The process begins with a referral from a heart failure specialist. Authorization from the insurance company is obtained for the evaluation, and the case is reviewed for any health concerns that may affect eligibility.

Education

Education is a key component. During the evaluation, patients learn about the transplant process and what to expect post-surgery. This includes understanding the risks and the care required after the transplant.

Medical Tests

Patients meet with a team including nurse practitioners, heart failure/transplant physicians, and transplant surgeons. Tests performed during the evaluation may include:

• Blood type and antibody testing for organ match compatibility
• Cancer screenings
• DEXA scan for bone density
• GFR testing for kidney function
• Hemoglobin A1C testing for diabetes
• Various imaging tests (X-rays, ultrasounds, CT scans)
• Pulmonary function tests
• Right heart cardiac catheterization
• Vaccine titer checks

Meetings with Specialists

Patients also meet with:

• A financial coordinator to discuss insurance and financial aspects
• A nutritionist to evaluate diet and discuss nutrition’s role in heart health
• A pharmacist to explain post-transplant medications
• A social worker to assess social support systems and mental health history

Determining Eligibility

A multispecialty heart transplant team meets weekly to review cases and decide the next steps. Possible outcomes include:

• Approval: The patient is added to the waiting list.
• Denial: The patient is not eligible for a transplant.
• Not eligible at this time: Additional testing or health concerns need to be addressed.

If You Are Not Eligible

If you do not qualify for a heart transplant, other options may include:

• Continuing or starting new heart failure medications
• Using a ventricular assist device
• Seeking a second opinion at another transplant center
• Receiving palliative care

Duration of the Evaluation Process

The initial tests are scheduled over two days, with the entire evaluation process taking 30 to 90 days. For critically ill patients in the hospital, the process is expedited and a decision is typically made within five to seven days. Regular communication with the transplant team is encouraged to manage anxiety during the evaluation and waiting period.

Conclusion

Heart transplant evaluation is a detailed and coordinated process, ensuring patients receive the best treatment options tailored to their individual needs.