An Overview of the Cardiac Transplantation Evaluation Process

When you are referred to NYP/Columbia for evaluation as a candidate for heart transplantation, you may be seen as an outpatient or admitted to the Hospital. The purpose of the evaluation is to determine if transplantation is the right choice for you.

You will have many tests, including blood and skin tests, X-rays, dental examination, and perhaps even cardiac catheterization. Some testing may be conducted locally and results faxed to the transplant office for review; this would be reviewed with your referring physician.

Sometimes a condition is discovered that would make transplantation too difficult or dangerous. This could be an active infection in the body, high blood pressure in the lungs, or severe thickening of the arteries. Or, if you were found to have a condition making it dangerous to take the steriod drugs that are used to prevent rejection after transplant, you might not be a suitable candidate.

During evaluation, you meet various members of the transplant team. The transplant coordinator will plan your care and provide answers to your questions. You consult with numerous physicians to discuss the specifics of the transplantation process. The program's psychiatrist, physical therapist and social worker each examine you from their care-giving perspective.

Most patients will require a full dental examination with X-rays to rule out any sources of hidden or potential infection. Infections in the mouth can be very troublesome if they occur after the transplant operation. Your local dentist can provide results of this exam to us. If you need referral to a dentist in the New York area we can provide a recommendation.

Women are typically required to have a complete gynecologic exam, including PAP smear and, if over 40 years of age, a mammogram. This can be done by your local gynecologist with results forwarded to the transplant coordinator.

A psychiatric evaluation provides us with insight into how you function emotionally and would be able to cope with the stress of the transplantation experience. If transplantation is recommended, the psychiatrist can help you and your family to deal with the stress of chronic illness, the difficulties of the long waiting period, the operation itself, and recuperation.

Because exercise is vital to your well-being after transplantation, a physical therapist will evaluate your current physical condition and the limitations caused by your illness. Your joint motion, muscle strength and condition will be evaluated. This assessment is done to be sure you can participate in a routine exercise program following your operation. All patients are encouraged to exercise regularly in the time leading up to surgery as well. The physical therapist can advise you regarding exercise and cardiac rehabilitation programs for before and after surgery. He or she will also teach you energy-conserving techniques to use while waiting for your new organ.

The social worker will meet with you and family members to learn as much as possible about your social support network, your coping strategies, your money status, and your feelings about your illness and the possibility of having a heart transplant. From the social worker and financial counselor you will learn about the many resources available to you, both within and outside of NYP/Columbia.

The evaluation process is not only for the team to gather information about you, but for you and your family to learn about our program, meet the team members and learn about what it means to be a transplant recipient. Ultimately, it will be you who must decide if you want to pursue cardiac transplantation at NYP/Columbia.