Page 8 - Heart Transplant Protocol

Heart Function Service: Heart Transplant Protocols

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
evaluation.
 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 November 9, 2017 8