Heart Transplant Process at University of Colorado Hospital

Before you receive a heart transplant, you will undergo a series of tests to determine your current health.

After these tests are performed, various members of the heart transplant medical team will give you a thorough evaluation.

Following your tests and evaluation, a cardiologist presents your case to the Patient Selection Committee for Heart Transplantation. The committee, which meets weekly, is made up of transplant program doctors, surgeons, nurse coordinators, social workers, clergy and psychiatrists. They determine whether a heart transplantation is a safe procedure for you. They also will discuss an optimal plan of care for you after transplantation.

Your transplant coordinator will inform you of the committee’s decision and plan.

Once you are accepted for transplant, your information is entered on the active heart transplant waiting list, and the search for a new heart for you begins.

Please note that every patient on the waiting list may be randomly screened for drugs or alcohol at any time.

The screening test may be done using a blood or urine sample. Anyone who tests positive for alcohol or illegal drugs will be removed from the waiting list.

After you have received a call to come to the hospital for your transplant surgery, you are admitted to the transplant unit. This is where preparation for surgery begins.

Upon arrival to the transplant center you will:

• Meet with your doctors and surgeons
• Sign one or more consent forms
• Have a few routine tests such as chest X-ray, EKG and blood draw
• Be given medications important for the success of your transplant

Your surgery will not begin until the donor heart:

• Arrives at the hospital
• Is examined by the transplant surgeon
• Is considered to be acceptable

Once the decision to proceed with the surgery has been made, you will be given an anesthetic to put you to sleep for the surgery.

Heart transplant surgery can be divided into four stages:

• Transfer of heart and lung function to bypass machine
• Removal of the old heart
• Replacement with the new heart
• Removal from bypass machine

Although there are several factors that may influence the difficulty of your surgery, the operation should last three to four hours.

Summary of procedure

An incision or cut is made in your chest. Special tubes are placed to connect you to a bypass machine. This machine does the work of your heart and lungs during the transplant. Your old heart is removed and replaced with the new organ. You will be disconnected from the bypass machine and your new heart will be connected to a pacer box and begin beating. The pacer box will control your heart rate and is usually only needed for a few days after surgery.

After your surgery you will be taken to a private room in the Intensive Care Unit (ICU) for recovery. Your stay in the ICU will usually last three to five days, but may be longer depending on your condition.

From the ICU, you will go to room in a specialized transplant unit. Here you will begin a closely monitored recovery process. You and your family will participate in various education sessions about your medication, diet, activities and follow-up care. Barring any complications, your stay in the unit usually lasts five to ten days.

Members of your medical team will monitor you closely for the first several months after you leave the hospital.

Initially, you will need to return for appointments and procedures two to three times a week for about one month. Visits will continue once a week for the next three months.

For the first month after transplant, you will have weekly heart biopsies. The biopsy is done by removing small pieces of the heart to be examined under a microscope for signs of rejection. The biopsies are not painful and only require numbing medication. As time passes these biopsies become less frequent. Eventually they will only be done every four to six months.

Long-term medical follow-up is extremely important so that any problems can be detected early and treated promptly. Common post-transplant problems may include:

• Rejection
• Infection
• Hypertension (high blood pressure)
• Coronary artery disease (blockages in the heart vessels)

Regular blood tests, biopsies and examinations help your doctors detect these problems early.

You will receive a complete list of symptoms that may be a sign of a problem. It's important that you report any signs to your transplant team immediately.

If you live outside the Denver area, your transplant coordinator will arrange for your long-term follow-up care to be managed by your local doctor and lab facility.

You will begin a diet and exercise plan while in the hospital, and you should continue that plan upon returning home. Following the plan is very important in regaining and maintaining day-to-day activities.

Your exercise plan is a step-by-step process:

• Sitting up and standing
• Walking in the hospital (as long as your biopsies are normal)
• Home walking program (you will be given an eight week walking schedule to follow as long as biopsies are normal)
• Walking is the most highly recommended form of exercise, but treadmills, bicycles or other equipment can be added slowly into your exercise program.
• Your breastbone will take six to eight weeks to heal. During this time you should not lift anything heavier than 10 pounds.

Benefits of exercise. Exercise for transplant patients has been shown to:

• Increase endurance
• Increase muscle strength
• Enhance bone remodeling
• Reduce the need for anti-hypertension medication

Proper nutrition. Proper nutrition also is critical for post-heart transplant patients. Certain medications you may take will affect the way your body processes food. You will receive medication guidelines related to your diet.

Your dietitian at the hospital will help you create meal plans that are both nutritious and low in calories. Following your diet is important in the total rehabilitation process, and for maintaining good health throughout your life with your new heart.