Page 6 - Heart Transplant Guidelines
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Heart Function Service: Heart Transplant Guidelines

               Outpatient Follow-up .................................................................................................................................. 44

                  Pre-transplant Outpatient Follow-up Guidelines.................................................................................... 44
                    Listed Status 1A: VAD Patient ............................................................................................................. 44

                    Listed Status 1B ................................................................................................................................... 44

                    Listed Status 2 ..................................................................................................................................... 44
                    Cardiac Catheterization ....................................................................................................................... 44

                    Infectious Disease Work Up ................................................................................................................ 45
                  Post-transplant Follow-up: Infant (< 1yr age at transplant) ................................................................... 46

                    Day of Transplant – 2 months (POD 60) ............................................................................................. 46
                    Month 2-4 Post Transplant (POD 120) ................................................................................................ 46

                    Month 4-6 months Post Transplant .................................................................................................... 46
                    Months 7-11 ........................................................................................................................................ 46

                    Month 12 following transplant ........................................................................................................... 46
                    Years 2-5 following transplant: ........................................................................................................... 47

                    >5 years following transplant: ............................................................................................................ 47

                  Post-transplant Follow-up: Child (> 1yr age at transplant) ..................................................................... 48
                    Day of Transplant – 2 months (POD 60) ............................................................................................. 48

                    Month 2-4 Post Transplant (POD 120) ................................................................................................ 48
                    Month 4-6 months Post Transplant .................................................................................................... 48

                    Months 7-11 ........................................................................................................................................ 48
                    Month 12 following transplant ........................................................................................................... 48

                    Years 2-5 following transplant: ........................................................................................................... 49

                    >5 years following transplant: ............................................................................................................ 49
                  Shared Care Arrangements ..................................................................................................................... 50

                  SOTP Policies in Policy Tracker ................................................................................................................ 51
                  Consent for Evaluation Form .................................................................................................................. 52

                  High Risk Donor Disclosure/Consent Form ............................................................................................. 56
                  HLA Requisition Form ............................................................................................................................. 60

                  C1Q Form ................................................................................................................................................ 62
                  Immunization Letter for Providers .......................................................................................................... 63

               Drug Protocols ............................................................................................................................................ 64
                  Protocol for Administration of Anti-thymocyte Globulin (Thymoglobulin) ............................................ 64






               Updated November 13, 2018                                                                    6
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