Q. What if I am having concerns about how to pay for the transplant?
A. Although patients are ultimately responsible for the costs associated with a transplant, financial resources are not the determining factor in selection for the transplant program. A transplant financial counselor, business office staff and transplant social workers will assist you and your family with questions about insurance coverage for your transplant and posttransplant medications.
Q. What is involved in evaluation testing prior to the transplant?
A. There is extensive cardiovascular testing, in addition to multiple tests that evaluate one’s general health. Transplant candidates should be in good overall health, since immunosuppressant medications taken after transplant are very hard on several body systems such as the bones, kidneys and liver. The goal of pretransplant testing is to ensure that a transplant will enhance your quality of life.
You will also have appointments with our social worker, infectious disease specialists and the transplant psychologist.
Q. How do I get on the heart transplant waiting list?
A. Once your testing has been completed, your case is presented to the Heart Patient Transplant Selection Committee, which includes cardiothoracic surgeons, transplant cardiologists, transplant coordinators, transplant social workers, infectious disease specialist and a transplant psychologist. This committee will review the evaluation testing and determine if a heart transplant is the best course of action for you.
If you are approved for transplant listing by the Heart Transplant Selection Committee, the final step involves approval by the Ohio Solid Organ Transplantation Consortium (OSOTC). The OSOTC has a committee comprised of representatives from other transplant programs and other members who approve all patients for heart transplant listing in the state of Ohio. When approved by the OSOTC, you are then listed for heart transplantation on the UNOS (United Network for Organ Sharing) national waiting list. It is important to note that you are not “on the waiting list” for transplant until you are told so by the heart transplant coordinator. A letter is sent to your insurance company providing recommendations for transplantation and requesting approval.
Donors are matched to recipients according to blood type, size, severity of illness and geographic location. Heart transplant candidates are classed into four categories, depending on the severity of illness:
- Status 1A: Critically ill, must have one of the following: on a ventilator, have a ventricular assist device, a VAD related complication, intra-aortic balloon pump or multiple inotropic medications with a hemodynamic monitoring device placed (Swan-Ganz monitor)
- Status 1B: May be in the hospital or at home on continuous inotropic support
- Status 2: Stable patient at home on oral therapy
- Status 7: Temporarily inactive (not accruing time, not able to be transplanted for multiple reasons, such as infection, recent surgery, personal issues, etc.)
Priority for donor hearts is given to the “sickest” patients first, starting with Status 1A.
Q. What happens during the waiting period before transplant?
A. During the waiting period, you will continue to follow up with heart failure physicians at The Ohio State University Medical Center. You must submit to random drug, nicotine and alcohol screening. You must be reachable at all times, usually with a cell phone.
Also after listing, you will meet with the transplant social worker and transplant coordinator, as will your family and any support persons identified for an orientation. You will sign a contract which details patient expectations and outlines expectations patients can have of the Ohio State's heart transplant team. During the orientation meeting, you will take part in a comprehensive education program that details the surgical procedure, medications, recovery and rehabilitation associated with the transplant process.
Q. What happens when a suitable heart is found?
A. If an organ is a good match for you, you will immediately be contacted.
Once you receive the call, you should not eat or drink anything from that time on, and you will be instructed to come to The Ohio State University Medical Center for admission to Ohio State’s Richard M. Ross Heart Hospital. You should always be within a two-hour drive of Columbus, due to tight time constraints before the transplant procedure.
Once you are admitted, you will undergo multiple laboratory tests, receive an X-ray, and begin your immunosupression medications. You will then go to surgery, usually within a few hours of admission.
One team of Ohio State's surgeons will travel to the donor hospital to recover the donor heart. If the heart is found to not be suitable for you, OSU may decline the heart, and you may be sent home. If the donor heart is found to be acceptable, the team will recover the organ and transport it back to Columbus.
At the same time, the recipient surgical team is preparing you for the heart’s arrival. Timing is critical to success of the transplant. The heart needs to be transplanted within four to six hours after donor recovery.
You will be in the operating room for approximately six hours, depending on individual circumstances.
Upon completion of the surgery, you will be taken to the Intensive Care Unit (ICU) and closely monitored for complications.
Q. How long will my hospital stay be?
A. The average length of stay for a heart transplant patient is seven to 14 days in the hospital. After discharge, frequent follow-up will be necessary, especially during the first three months post transplant.
Q. How will I adjust to the lifestyle and nutritional changes I’ll need to make after surgery?
A. Licensed Independent Social Workers (LISW) specially trained in transplant, assist you in adjusting to lifestyle changes brought on by your disease and its treatment. A registered dietitian specializing in the care of transplant patients will assist you by individualizing your nutritional care and educating you about your dietary needs.