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

                    Listed Status 1B ................................................................................................................................... 43

                    Listed Status 2 ..................................................................................................................................... 43
                    Cardiac Catheterization ....................................................................................................................... 43

                    Infectious Disease Work Up ................................................................................................................ 44

                  Post-transplant Follow-up: Infant (< 1yr age at transplant) ................................................................... 45
                    Day of Transplant – 2 months (POD 60) ............................................................................................. 45

                    Month 2-4 Post Transplant (POD 120) ................................................................................................ 45
                    Month 4-6 months Post Transplant .................................................................................................... 45

                    Months 7-11 ........................................................................................................................................ 45
                    Month 12 following transplant ........................................................................................................... 45

                    Years 2-5 following transplant: ........................................................................................................... 46
                    >5 years following transplant: ............................................................................................................ 46

                  Post-transplant Follow-up: Child (> 1yr age at transplant) ..................................................................... 47
                    Day of Transplant – 2 months (POD 60) ............................................................................................. 47

                    Month 2-4 Post Transplant (POD 120) ................................................................................................ 47

                    Month 4-6 months Post Transplant .................................................................................................... 47
                    Months 7-11 ........................................................................................................................................ 47

                    Month 12 following transplant ........................................................................................................... 47
                    Years 2-5 following transplant: ........................................................................................................... 48

                    >5 years following transplant: ............................................................................................................ 48
                  Shared Care Arrangements ..................................................................................................................... 49

                  SOTP Policies in Policy Tracker ................................................................................................................ 50

                  Consent for Evaluation Form .................................................................................................................. 51
                  High Risk Donor Disclosure/Consent Form ............................................................................................. 55

                  HLA Requisition Form ............................................................................................................................. 59
                  C1Q Form ................................................................................................................................................ 61

                  Immunization Letter for Providers .......................................................................................................... 62
               Drug Protocols ............................................................................................................................................ 63

                  Protocol for Administration of Anti-thymocyte Globulin (Thymoglobulin) ............................................ 63
                    Premedication: .................................................................................................................................... 63

                    Dosing: ................................................................................................................................................ 63
                    IV Infusion: .......................................................................................................................................... 63






               Updated May 17, 2018                                                                         6
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