Page 40 - Heart Transplant Protocol
P. 40

Heart Function Service: Heart Transplant Protocols

                   Varicella IgM
                                                   DIAGNOSTIC STUDIES

                   CXR AP and Lateral                        Cardiac Catheterization
                   ECHO                                      Dependent on Patient Status:
                   EKG- 15 Lead                                 o Head CT/Head MRI
                   Abdominal Ultrasound                         o CT Heart w contrast (all patients with prior
                   Head Ultrasound (<1yo)                         sternotomies)
                   Pulmonary Function Test (age appropriate)    o CT of Sinus without contrast
                   Metabolic Stress Test                        o Ultrasound of cervical and femoral vessels
                   Holter Monitor
                                                         CONSULTS
                   CT Surgery                                Chaplain
                   Neurology                                 Social Work
                   Infectious Disease                        Child Life
                   Nephrology                                Palliative Care
                   Genetics                                  Pharmacy
                   Nutrition                                 Financial
                   Psychology                                Dental Evaluation
                                                    PRA Lab Follow-up
                   Email HLA lab for cPRA                    Email HLA lab for what to block in UNOS

                                                          RECORDS
                   Immunization Record                       Developmental/School Records
                   Social Security Card                      Outside Hospital Records
                   All physician as part of patients medical
                    team confirmed in EPIC
                                                     Insurance/Listing
                   Insurance information given to Financial    Verbal Consent to List Patient
                   Financial Approval                        Letter for Listing Approval (LOMN)
                   Consent to Evaluate                       Family Listing Letter Sent

                                                     Candidate Listing
                   Phoenix initiated                         Active List updated
                   Letter to referring physician             ABO Protocol initiated if appropriate
                   Phone call made to referring physician





















               Updated November 9, 2017                                                                    40
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