Page 8 - Heart Transplant Guidelines
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Heart Function Service: Heart Transplant Guidelines

                                                  Transplant Evaluation

               Role of Each Consult Service during Pre-Transplant Evaluation

               Pre-Transplant Medical Assessment
                   •  All patients will be assessed by the transplant medical team, including a full H&P,
                       medical history, surgical history, physical exam, current medications, and will be
                       documented in EPIC.
                   •  The medical team will obtain all outside images and have them uploaded in our system.
                   •   The medical team will give the family the initial transplant talk and obtain consent for
                   •  All evaluation labs and procedures will be ordered once consent obtained and will
                       follow-up on the results.
                   •  The medical team will present each patient during selection committee to the
                       transplant team once evaluation is complete.

               Pre-Transplant Surgical Assessment
                   •  All patients who are assessed for heart transplant will be reviewed by the cardiac
                       surgical team. The surgical assessment and plan will be documented in EPIC. The
                       assessment summary includes the following:
                   •  Detailed anatomy including systemic and pulmonary venous abnormalities, size and
                       status of branch pulmonary arteries, relationship of the great arteries, and any anatomic
                       information relevant to transplantation.
                   •  Detailed information about previous surgeries, reconstructions, ECMO cannulation,
                       pleurodesis, and diaphragm plication.
                   •  Re-entry risk based on a cross-sectional imaging (CT or MRI). The re-entry risk will be
                       graded as low, moderate, and high. Based on the risk profile, a re-entry plan (peripheral
                       vessels prepped only, exposed or cannulated) will be recommended in the document.

                   •  Peripheral vessel size and patency based on neck and groin ultrasound. An appropriate
                       access site will be noted.

                   •  Reconstruction plan including superior vena cava (SVC), branch pulmonary arteries (PA),
                       aortic arch.
                   •  Suggestions regarding donor travel time, donor size, and estimation of required time for
                       chest re-entry/dissection.
               Pre-Transplant Infectious Disease Assessment
                   •  All patients will be evaluated by the infectious disease service and assessed for risk
                       factors of infectious complications following transplantation, including immunization
                       histories, travel histories and prior infections / associated treatments.
                   •    ID will create an immunization schedule and provide treatment recommendations
                       as needed prior to transplant.

               Updated December 14, 2018                                                                    8
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