Heart Transplant Program

There are many clinical conditions that qualify for consideration for heart transplantation, namely advanced cardiac disease failing traditional therapies. However the rules for being listed for transplant and the ranking on this list are complex. The transplant team will review this information with you when appropriate.

One criterion for being on the transplant list is the ability to get to our facility within four hours. You can accomplish this by simply driving, arranging after-hours air flight capability or temporarily moving closer to the transplant hospital.

After the transplant, you must live within 50 miles of the transplant hospital for the first 6-8 weeks. Baylor University Medical Center at Dallas has a low-cost on-campus apartment, Twice Blessed House, where patients and their families may live during this time.

We have a financial coordinator who will help you and your family with financial related questions or concerns regarding your transplant coverage.

The transplant evaluation starts with a comprehensive review of your past medical history by a transplant cardiologist. You'll meet with the transplant cardiologist to discuss the nature and prognosis of your cardiac disease and determine if any other traditional treatments would be beneficial prior to consideration of a cardiac transplant. Certain cardiac tests may need to be performed that are different from prior tests you may have had with your cardiologist.

The next step involves determining if your body is well enough to achieve a successful outcome from a cardiac transplant. This also involves a lot of testing and consultations. A team of specialists including physicians, nurses, social workers, behavioral health professionals and transplant coordinators will meet to review your case and determine your best course of care and potential for listing.

The transplant team will consider all the information from interviews, health history, physical exam and diagnostic test results when deciding if you are eligible for a heart transplant.

Unfortunately, there is no way to predict how long it will take. Several factors including blood type, body size, severity of illness and presence of antibodies all play a part in the waiting time.

Candidates are now listed according to six medical urgency statuses. Status 1 is the most urgent and Status 6 is the least urgent. While there are highly detailed criteria for status assignments, several basic factors will be considered:

• If you are on one or more advanced support devices requiring hospitalization then you will have higher priority. If you are stable on a VAD or medications as an outpatient, then you will have lower priority.
• Blood type O waits longer than other blood types
• Larger body size waits longer for an appropriate sized donor
• Other medical conditions can also factor into your listing status

We will list you in the applicable status.

Once on a transplant list, you will be followed regularly by the transplant team and medical adjustments are often made. Sometimes hospitalization may be required and moving up to a higher status can occur. Sometimes you can become too sick for transplant and you would be inactivated (status 7) and efforts to improve your condition to the point of medical stability will be attempted.

Each transplant center is located within a specific region served by a specific organ bank and a specific recipient list. Organs are offered by the organ bank to the facilities based on a complex national allocation system based on severity of illness, blood type and distance from the donor hospital.

No matter how well prepared you feel, it is often still a shock to get the call. You will be notified that a suitable donor has been identified and matched to you. You will be instructed as to when to get to the hospital, often as quickly as possible, which is why there are distance limitations of how far away from the transplant center you may live. Simply have a to-go bag ready with simple necessities (sort of like preparing for the birth of a baby) and get to the center as directed.

Upon arrival there will be a flurry of activity - an IV will be placed, blood work drawn, X-ray taken, paperwork to fill out, visitation by several medical personnel, etc. Often the initial time given to you changes since several transplant teams for each organ have to be coordinated to arrive at the same time to the donor. Simply take a deep breath, relax and try not to worry.

After the heart transplant surgery, the usual time in the ICU is one to three days and then four to 10 days on the transplant floor. The sicker and weaker you are going into to the surgery, the longer it will take to recover after the surgery, and some patients require a rehab facility afterwards for further strengthening. During this time, you will be closely monitored and educated as to the new medications and possible issues you may be facing after the transplant. You will receive a post heart transplant manual after your surgery.

Medications

Immediately after your heart transplant operation, you'll be started on special medications to maximize the survival benefit of the transplant. These are on top of the other medicines you have been taking for your non-cardiac conditions. Over the first year, your transplant team may adjust several of the medicines. You'll be weaned down or off some, and others may be increased.

• Immunosuppressants – These medications are to help prevent a heart transplant rejection by suppressing your body's natural immune responses.
• Antibiotics, antivirals, antifungals – These medications are to assist in preventing infections that you are more prone to since your immune system is weakened.
• Vitamins, minerals - These medications help the body in the healing process and maintaining good health.
• Cholesterol medications – These medications help prevent the development of coronary artery disease in your new heart.
• Blood pressure medications – Most transplant recipients develop hypertension and thus require blood pressure medicines.

Returning to Work

The appropriate time to return to work depends on several factors - how ill you were prior to your heart transplant surgery, how long it takes you to recover after the surgery and what type of work you are doing. Once your incisions heal and you are feeling well, you will discuss this timing with your transplant team. Some are able to return to work in a matter of weeks, others could be months.

Your team wants you to return to work as soon as it is safe to do so. If you were on cardiac disability at the time of your heart transplant operation, this will remain in effect until one year after the transplant. After the first year, cardiac disability is no longer in effect and you could lose those benefits.

Heart transplant recipients take many medications to maximize the survival benefit of the transplant. Immediately after the transplant most of the medications are started on top of your other medicines you have been taking for your non-cardiac conditions. Over the first year, several of the medicines will be adjusted by your transplant team. Some will be weaned down or off and some may be increased.

• Immunosuppressants - These medications are to help prevent rejection of the heart by suppression your body's natural immune responses.
• Antibiotics, antivirals, antifungals - These medications are to assist in preventing infections that you are more prone to since your immune system is weakened.
• Vitamins, minerals - These medications help the body in the healing process and maintaining good health.
• Cholesterol medications - These medications help prevent the development of coronary artery disease in your new heart.
• Blood pressure medications - Most transplant recipients develop hypertension and thus require blood pressure medicines.

After your discharge, you will be closely monitored by the entire transplant team, which includes the transplant cardiologist, advanced care practice nurses and coordinators. You will be given a specific schedule of visits, which will include blood work, chest X-rays, clinic exams and heart biopsies. The transplant team will send updates to your referring cardiologist and primary care physician. All of your medical care the first year will be under the transplant team.

After the first year, you will be returned to your primary care physician and you will see the transplant team less frequently. However, you will see the transplant team for your entire life with biannual checkups to monitor for any complications associated with life-long immunosuppression or rejection of the heart.

Medication side effects – There is a long list of potential side effects from all of the medicines. The most common include tremors, insomnia, nausea, diarrhea and high blood pressure.

Rejection – This occurs when your immune system reacts to your heart and tries to damage it. We are in constant surveillance for this problem with biopsies and specialized blood tests, so that most of the time, we find early rejection before symptoms develop or damage occurs. Early treatment is critical to successfully reversing rejection. Do not try to treat your symptoms yourself. This is why staying with your follow-up schedule is so important. If a rejection is detected, your oral immunosuppression medications may be adjusted or you may receive additional treatments. This is most likely to occur in the first year.

Infections – Because your immune system is suppressed, infections are a real risk. Some medications are given to prevent infections. Other times, we watch for early signs of infection and treat at that time. The greatest danger for this is the early months after transplant when your immune suppression meds are at their highest doses.

Cancer – because your immune system is suppressed, cancers are a lifelong risk. The immune system is responsible for scanning our body for abnormal cells and now will be less able to do this. That is why you will have lifelong screening tests and see the transplant team for life to look for evidence of cancer early. Most cancers, when found early, can be treated effectively.