Page 6 - Heart Transplant Protocol
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Heart Function Service: Heart Transplant Protocols

                    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
                    Anaphylaxis: ........................................................................................................................................ 63






               Updated February 27, 2018                                                                    6
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