Your heart specialist may ask that you be evaluated for a heart transplant if he or she believes that your heart disease is so advanced that there are no other treatment options and that you would be a good candidate for this surgery.
A number of different conditions can damage your heart to the point where other treatments are unsuccessful and a transplant is the best chance for cure. These include:
Other conditions may exclude a patient from consideration for a transplant, such as irreversible pulmonary hypertension, cancer, HIV, active drug or alcohol addiction, acute mental incompetence and severe muscle loss due to malnutrition, called cardiac cachexia. A number of other conditions are evaluated on an individual basis to determine transplant suitability.
Once it is determined that you would benefit from transplant surgery, your name will be placed on a waiting list to receive a donor heart. There currently are not enough donor hearts available for the people who need them. Under national regulations, hearts must go to the sickest patients first in a given area.
Research currently is being done to evaluate devices that potentially could act as a "bridge" to transplantation by replacing heart function with a machine until a donor heart is available.
Our staff will determine your general suitability for transplantation using preliminary information from your referring doctor. After this initial assessment, a very comprehensive evaluation is conducted. Our approach to this is flexible although we do insist that every potential candidate and their family visit UCSF Medical Center at least once before the transplant.
All candidates are seen by UCSF's transplant team that includes a cardiologist, surgeon, transplant coordinator and social worker. If the patient lives far away from San Francisco, the team works with the referring doctor to complete portions of the pre-transplant selection protocol in your local community.
The pre-transplant evaluation includes assessment of both the cardiac and extra-cardiac systems. Stable patients usually are able to complete the standard pre-transplant selection protocol on an outpatient basis.
One of the most important components of the cardiac evaluation is an assessment of pulmonary vascular health. If the patient has pulmonary hypertension, it is essential to determine its severity and potential for cure. These trials are conducted in the hospital with right heart catheterization and continuous hemodynamic monitoring often for periods of six to 12 hours. Because the outcome of these trials is pivotal in determining the patient's suitability for transplant, we prefer to perform this part of the assessment at UCSF Medical Center.
Additional routine components of the cardiac assessment include:
Some patients also may need formal cardiac catheterization, including coronary angiography and ventriculography, myocardial biopsy and electrophysiologic studies.
In addition, there are a number of non-heart-related tests and other components that are part of the pre-transplant evaluation, including:
Depending on your specific situation, additional tests may be run during the initial screening.
While the main focus of the evaluation is to determine whether the patient is a suitable candidate for transplantation, the team also works with the patient and family to resolve any potentially reversible conditions such as smoking, drug addition, obesity, mental distress, financial problems and so on.
The selection of patients for heart transplantation is based on a recommendation from the multidisciplinary heart transplant team that is comprised of representatives from various departments including surgery, internal medicine, nursing, psychiatry, social work, pathology and hospital administration. The potential heart transplant candidate's case is presented at the weekly transplant meeting after the members of the team complete the interviewing process and the patient completes all pre-transplant testing.
After this discussion, the team will decide to do one of the following:
All decisions of the committee are based upon group consensus. In difficult cases, the medical center's ethics committee is available to offer their expertise.
Patients deemed to be acceptable candidates for transplantation are listed nationally with the California Transplant Donor Network. The listing is made according to the organ(s) required, heart or both heart and lung, blood group and acceptable donor height range. Allocation of donor hearts is done at the local and regional level strictly according to national policy. The two main features of this policy include the following:
Most patients continue to receive all of their medical care from doctors in their local community. A few choose to transfer their care to UCSF Medical Center. In either case we maintain close contact with the patient's referring doctor.
All patients on the waiting list are seen by the transplant cardiologist and transplant coordinator in the outpatient clinic every three months or as dictated by his or her medical condition. During these visits the patient's continued candidacy for transplantation is reassessed and, if necessary, further medical consultations or studies are performed. These visits usually coincide with the monthly meetings of the Transplant Program's support group, which patients on the waiting list are encouraged to attend.
Local doctors immediately inform the transplant team if a medical condition arises that could affect the patient's transplantation eligibility. If the patient's clinical condition warrants, they may be temporarily or permanently removed from the "active" waiting list. Patients whose clinical condition deteriorates while on the waiting list are either admitted directly or transferred to UCSF Medical Center from the community hospital once his or her condition has stabilized.
The Transplant Program has access to a variety of medications and devices, including pacemakers, defibrillators and ventricular assistance devices, to support patients with severe heart disease until they can be transplanted.
UCSF Medical Center is a member of the United Network for Organ Sharing (UNOS) and a founding member of the California Transplant Donor Network (CTDN), an independent regional organ procurement organization supported by regional transplant centers. The network has developed and maintains working relationships with more than 150 hospitals in Northern and Central California as well as Northern Nevada where it assists in the identification of potential donors, provides donor management, procurement, preservation, transportation and distribution of donor organs as well as formal and informal education concerning organ donation and transplantation.
Reviewed by health care specialists at UCSF Medical Center.