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Before Transplant

Pretransplant Referral

Your own cardiologist will make a referral for you to be evaluated for transplantation appropriateness at Ohio State’s Richard M. Ross Heart Hospital. Here are some of the steps in the pretransplant referral process:

1. The referring party is responsible for providing the coordinator with all applicable medical information according to the transplant referral protocol provided at time of referral.

2. You will need to notify your insurance company before making your initial evaluation appointment. Our pretransplant office and hospital business office will work with you to determine insurance availability and pre-certification requirements.

3. Heart transplant coordinators and business office staff then work together to meet insurance company requirements for evaluation and transplant procedure approval.

Evaluation

You will be seen initially by one of Ohio State's Medical Center Heart Failure specialists to determine whether you are a transplant candidate. If so, you will be scheduled for a full outpatient clinic evaluation.

It will be determined if there is a need for additional medical or surgical therapy before transplant evaluation testing is initiated. A transplant should be a last-resort therapy, due to the limited supply of organs and overwhelming demand.

Before Transplant

Once you are deemed a potential candidate, you will meet the transplant coordinator and be scheduled for evaluation testing to be done at Ohio State.

The testing includes extensive cardiovascular testing, in addition to multiple tests that evaluate one’s general health. Transplant candidates should be in good overall health, since immunosuppressant medications taken after transplant are very hard on several body systems such as the bones, kidneys and liver. The goal of the pretransplant testing being done is to ensure that a transplant will enhance the your quality of life. 

You will also have consultations with our social worker, infectious disease specialists and the transplant psychologist.

Psychosocial Evaluation

Every patient being evaluated for a heart transplant will have a psychosocial assessment with a social worker. The purpose of this evaluation is to help determine if a transplant candidate has the psychological stability, motivation and personal support to meet the challenges of transplantation.

The assessment will cover:

  • your insurance coverage and ability to afford surgical and medication expenses
  • your support system, (including primary and secondary caregivers)
  • knowledge of the transplant process and coping skills required to deal with the stress of the waiting period, hospitalization and recovery
  • psychiatric history including any current psychiatric problems
  • track record of compliance with medical appointments and medications
  • chemical dependency

After the psychiatric history, if further chemical dependency evaluation is warranted it will be conducted by the clinical psychologist, Talbot Hall or another licensed facility. All patients must meet the chemical dependency requirements of the State of Ohio Solid Organ Transplant Consortium. The use of tobacco, alcohol and/or illicit drugs is carefully examined. Patients who meet criteria for alcohol or drug dependence must undergo at least six months of rehabilitation and demonstrate a minimum of six months of abstinence before listing. Finally, the patient’s track record of compliance with medical appointments and medications will be assessed.

Our staff may also refer patients to see the transplant psychologist. This will involve further assessment of any psychological factors that may interfere with a successful transplant outcome. After this evaluation is complete, a report is sent to the team with a recommendation about the patient’s suitability for transplant from a psychosocial perspective.

Education

During the orientation meeting, you will take part in a comprehensive education program that details the surgical procedure, medications, recovery and rehabilitation associated with the transplant process. During the waiting period, the main focus is on educating you and your family about the following:

  • patient’s responsibilities and role in the process
  • what happens clinically during surgery and recovery
  • potential complications
  • lifestyle modifications
  • drug therapy
  • cost factors
  • support groups
  • further evaluation

You may also be offered other therapies until you meet the criteria for a heart transplant. Referral could be made to Cardiology, Cardiac Surgery, Pulmonary, Infectious Disease or other services as warranted.

Approval

Once your testing has been completed, your case is presented to the Heart Transplant Patient Selection Committee, which includes cardiothoracic surgeons, transplant cardiologists, transplant coordinators, our social worker, infectious disease specialist and psychologist. This committee will review the evaluation testing and determine if a heart transplant is the best course of action for you.

If you are approved for transplant listing by the heart transplant selection committee, the final step involves approval by the Ohio Solid Organ Transplantation Consortium (OSOTC). The OSOTC has a committee comprised of representatives from other transplant programs and other members who approve all patients for heart transplant listing in the state of Ohio. When approved by the OSOTC, you are then listed for heart transplantation on the United Network for Organ Sharing (UNOS) national waiting list. It is important to note that you are not “on the waiting list” for transplant until you are told so by the heart transplant coordinator. A letter is sent to your insurance company providing recommendations for transplantation and requesting approval.

Donors are registered on the same list and matched to recipients according to blood type, size, severity of illness and geographic location. Heart transplant candidates are classed into four categories, depending on the severity of illness:

  • Status 1A: Critically ill, must have one of the following: on ventilator, ventricular assist device (good for 30 days useable at any time post VAD), VAD related complication,  intra-aortic balloon pump or multiple inotropic medications with a hemodynamic monitoring device placed (Swan-Ganz monitor)
  • Status 1B: May be in the hospital or at home on continuous inotropic support (single inotrope)
  • Status 2: Stable patient at home on oral therapy
  • Status 7: Temporarily inactive (not accruing time, not able to be transplanted for multiple reasons, such as infection, recent surgery, personal issues, etc.)

Priority for donor hearts is given to the “sickest” patients first, starting with Status 1A.

Waiting

Your wait time can depend on multiple factors such as your blood type, your size and the severity of your illness. The wait time could be from days to years.

During the waiting period, you will continue to follow up with Ohio State heart failure physicians. You must submit to random drug, nicotine and alcohol screening. You must be reachable at all times, usually with a cell phone.

Also after listing, you will meet with our social worker and transplant coordinator, as will your family and any support persons identified for an orientation. You will sign a contract which details patient expectations and outlines expectations patients can have of Ohio State’s heart transplant team. During the orientation meeting, patients take part in a comprehensive education program that details the surgical procedure, medications, recovery and rehabilitation associated with the transplant process. During the waiting period, the main focus is on providing you and your family about the following:

  • patient’s responsibilities and role in the process
  • what happens clinically during surgery and recovery
  • potential complications
  • lifestyle modifications
  • drug therapy
  • cost factors
  • support groups
  • further evaluation

Please view During Your Transplant for more information.