The Four Steps to Your Successful Transplantation

Typically, patients are referred to our program by a physician for assessment as a lung or heart-lung transplant candidate, but you may contact us directly about your condition. Once you arrive for assessment at Columbia Presbyterian, you become part of an intensely personal, four-phase program designed to guide you and your family through this challenging time.

I - The Evaluation Phase

Members of Columbia Presbyterian's transplant team conduct a careful and comprehensive evaluation of your physical condition. Necessary tests are performed, including pulmonary function testing (PFT), x-rays and blood tests. Your dental health and bone strength are evaluated.

You meet with the team's coordinator, social worker, psychiatrist, and financial counselor to help you understand and find ways to minimize the personal impact transplantation would invariably have on you and your family. Results are generally complete within a few days of the examination. Then, the team analyzes all the test data and consultation results to determine if transplantation is the correct therapy for you. This evaluation phase is typically completed within 60 days. At the end of the evaluation, an individualized action plan is created for you. If you are accepted as a transplant candidate, you are registered on the organ recipient waiting list of the United Network for Organ Sharing. If transplantation is not right for you, alternative therapies are recommended.

II - The Waiting Period

The United Network for Organ Sharing (UNOS) is the national clearinghouse for organ allocation. UNOS was created to maximize the limited supply of organs and give all candidates a fair chance to receive the organ they need, regardless of gender, race, religion, lifestyle, or financial or social status. It manages the national transplant waiting list, matching donors to recipients 24 hours a day, 365 days a year, for every transplant center in the country.

In the New York region, most patients wait from 10 to 14 months for their replacement organ(s) to become available. During your wait, it is critical for you to maintain good nutrition and keep up rehabilitation efforts under the care of your local physician. Most transplant recipients will tell you that this waiting time was the most difficult part of their entire transplant experience. The transplant coordinator and social worker serve as your advocates, recommending and facilitating the support services you may require.

III - Your Transplant Operation

Columbia Presbyterian does not require that you relocate to the Manhattan area when you join its transplant program. However, you must be able to reach the campus in northern Manhattan within several hours of receiving notice that your new organ is available; your transplant coordinator will have helped you plan your transportation well in advance of this call. From the moment you arrive at Columbia Presbyterian, you are under the continuous care of your transplant team.

The operating rooms in the Milstein Hospital Building are staffed by attending surgeons and full-time cardiac anesthesiologists, who jointly lead the team that includes surgical residents, perfusionists, physician assistants, and nurse practitioners. They are further supported by a sophisticated cardiothoracic intensive care unit, where you receive one-on-one nursing care, under the direction of your surgeon and pulmonologist. Following surgery, you recover in this intensive care unit until you are ready to return to your room.

Throughout your stay at Columbia Presbyterian, the transplant team is there to help you achieve the earliest possible medically appropriate return home.

IV - After Your Transplant

Following your surgery, you remain in the hospital or transfer to a recommended rehabilitation facility to optimize recovery and guard against infection and organ rejection. From there, you begin the life-long process of returning to and maintaining pulmonary health.

You continue to work closely with your transplant pulmonologist, your physical therapist, and members of the social services team. Your local physician remains a key member of the care-giving team, playing an active role in your recovery. In the first few months following surgery, you return weekly to Columbia Presbyterian for checkups.

After four months, the frequency of these visits decreases to once a month. During this time, you take a number of medications that are important to maintaining the health of your new organ(s). The transplant team works with you to make sure that you fully understand the purpose of these medications and are comfortable with the related instructions.

At follow-up visits, you participate in a regular schedule of diagnostic and medical care, including physical examination, complete blood and x-ray analysis, review of medications, bronchoscopy, dental care with antibiotic prophylaxis as needed, and annual eye and, for women, gynecologic care.