Patients who may be helped by a heart transplant undergo an extensive evaluation of their heart disease and general health by the Penn Heart Transplant Team. The evaluation period is a time of learning for patients and their families. During the evaluation, the heart transplant nurse collects the patient evaluation information and presents it to the heart transplant team for discussion at a weekly meeting. The evaluation process provides information for the team to determine if the patient's condition is severe enough for a heart transplant and if transplant is a valid option.
Typically, the evaluation includes two days of outpatient testing and interviews. Patients who are very sick may be evaluated while they are in the hospital. The evaluation includes assessments of both the cardiovascular system and the body as a whole.
Cardiovascular testing includes:
- Chest X-ray and/or CT scan: Pictures of the heart and lungs
- Electrocardiogram (EKG): Measures the electrical activity of the heart taken through patches applied to the skin
- Echocardiogram: An ultrasound of the heart that reveals size and heart muscle function, as well as the valve function
- Exercise stress test: Measures how well the heart is supplying oxygen to the body. Patients walk on a treadmill while their heart and oxygen levels are monitored
- Right heart catheterization: Measures the pressure in the heart and lungs. A catheter for monitoring pressure is passed through a vein in the groin or neck and into the heart
General health information includes a history of immunizations, medical information and dental health, as well as the following tests:
- Pulmonary function test (PFT): Determines air volume in the lungs and identifies lung conditions that might be a problem after transplant
- TB skin test: Identifies exposure to tuberculosis
- Blood tests: Identifies blood type; tissue type; varicella zoster, hepatitis (A, B and C), toxoplasmosis, cytomegalovirus (CMV), and HIV; tests immune system, kidney and liver function and thyroid function.
- Cancer screening tests: Determine if cancer is present. May include a colonoscopy and/or prostate specific antigen (PSA) for men, and a mammogram and/or Pap smear for women
- Urinalysis and 24-hour urine testing
- Peripheral vascular/carotid artery studies: Measure blood flow to the brain and legs, and identify any blockages in the blood vessels
- Abdominal ultrasound: Checks for masses, cysts and aneurysms in the abdominal organs and blood vessels
During the evaluation, certain conditions may be identified that may prompt additional testing and consultations to further determine transplant candidacy. These concerns and appropriate treatments are discussed with patients and family members.
If the heart transplant team decides that transplant is the best option and patients agree, patients are "listed for transplant."