The pancreas, located below your liver and under your stomach, is about seven inches long and weighs about 3.5 ounces. It has two main functions. The first is to help digest food by making and releasing enzymes in the upper portion of the small intestine. Carbohydrates, fats and proteins are broken down into small parts that the body uses as nourishment. In addition, the pancreas makes large amounts of sodium bicarbonate, which can make the contents of the stomach less caustic or acidic as they flow through the small intestine. Sodium bicarbonate also helps keep fluids in the body and prevent dehydration.

The other job of the pancreas is to make insulin, a hormone necessary for the body to use carbohydrates properly. If you don’t produce insulin, you have a disease called diabetes.

A pancreas transplant can help manage the organ damage that may result from insulin-dependent diabetes. A successful pancreas transplant will eliminate the need for insulin injections, reduce or eliminate dietary and activity restrictions due to diabetes, and decrease or eliminate the risk of severe low blood sugar reactions.

The prognosis after pancreas transplantation is very good. One year after transplantation more than 95% of all patients are still alive and 80-85% of all pancreases are still functional.

Patients with type 1 diabetes may be evaluated for pancreas and kidney-pancreas transplants. Patients with type 2 diabetes are less likely to be candidates for a pancreas transplant because they may be insulin-resistant and unable to reap the benefits of a pancreas transplant.

One of the most serious complications of type 1 diabetes is end-stage renal disease (ESRD) or end-stage kidney disease, which may require a kidney transplant. A kidney transplant without a pancreas transplant means you must take antirejection medication for the kidney and continue to take insulin.

The possibility of diabetes damaging the new kidney and other organs also remains. Successful combined kidney-pancreas transplants prevent diabetic damage in newly transplanted kidneys as well as eliminate the need for insulin therapy. In the best case scenario, a patient would receive a new kidney and pancreas from the same donor.

For the evaluation for a pancreas transplant, you will undergo a number of tests. Some of them are:

• Blood tests, including an HIV (AIDS) test, within the last year.
• Chest X-ray within the last year.
• Creatinine clearance testing for those not on dialysis. This test, conducted over a 24-hour period, compares how much creatinine a blood waste product occurs in the blood and in the urine to evaluate kidney function.
• Echocardiogram within the last two years. This test uses sound to create a picture of heart function.
• Electrocardiogram (EKG or ECG) within the last year.
• Persantine thallium or comparable test within the last two years. This test involves intravenous application of persantine to help expand the arteries and replicate the effect of vigorous exercise, and of thallium, a radioactive isotope detected by X-ray.
• Stool guaiac, which is a test for blood in stools.
• Tuberculosis (TB) skin test.

Other tests may be required — depending on your gender, age and medical history — such as a colonoscopy, mammogram, Pap smear or prostate specific antigen (PSA) test. Additional testing may be ordered, based on results of these tests.

Patients who undergo pancreas transplant, also must have a designated caregiver for assistance after the surgery. This person is needed to help bring you to clinic appointments and help you at home during the first days after leaving the hospital.

Because there’s a shortage of donor pancreases, patients must wait for an available organ. These wait periods vary depending on blood type. In general, pancreas and kidney-pancreas wait times are shorter than the wait times for a kidney alone.

Kidneys and pancreases may be provided by a cadaveric donor, or a person who is brain dead. Kidneys also may be provided by a living donor who donates one of his or her kidneys and survives on the remaining kidney. While live kidney donors don’t have to be blood relatives, they must have a compatible blood type. Donors may be excluded for high blood pressure, obesity, diabetes or history of cancer.

Complications immediately after surgery include:

• Thrombosis
• Pancreatitis
• Infection
• Bleeding
• Rejection

Rejection may occur immediately or at any time during the patient’s life. This is because the recipient’s immune system considers the new organ as foreign object and will try to combat it. Organ rejection is a serious condition and ought to be treated immediately. To prevent rejection, patients must take powerful anti-rejection medications for the rest of their lives. These medications have many side effects and makes patients more susceptible to other illnesses, including cancer.

Pancreatic Islet Transplant

Clusters of cells, called the islets of Langerhans, are spread throughout the pancreas. Islets are made up of two types of cells — the alpha cells, which make glucagon, a hormone that raises the level of glucose or sugar in the blood and the beta cells, which make insulin.

In a minimally invasive procedure, insulin-producing beta cells are isolated from a donor pancreas, then injected through the skin into the portal vein of the liver, where they attach to new blood vessels and release insulin. For an average-size person, a typical islet transplant requires about one million islets, equal to two donor organs.

Lung disease is characterized by the inability to breathe — that most basic of all human biological functions. People with lung disease are likely to experience shortness of breath, chronic cough and exhaustion. If the condition is severe and untreated, the patient eventually will die.

Lung transplantation for patients with severe diseases of the lung — such as emphysema, cystic fibrosis, pulmonary fibrosis, sarcoidosis and pulmonary hypertension — is considered only after all other treatments have failed. In some cases, congenital heart disease may cause advanced lung disease, requiring repair of these heart defects at the time of lung transplantation.

To be eligible for a lung transplant, you must meet the following requirements:

• You must be physiologically 60 years of age or less for bilateral lung transplantation and 65 years of age or less for single lung transplantation. This means that your physical condition must at least meet the typical condition of someone 60 years old or younger, or someone 65 years old or younger. Your chronological age is not a factor.
• You must have a poor prognosis, with an anticipated 18 to 24-month survival.
• You must have no other life-threatening systemic disease.
• You must have demonstrated absolute compliance with medications and medical recommendations, and have good rehabilitation potential.
• You must demonstrate emotional stability and must have a realistic understanding of the implications of organ transplantation.
• You must have a good social support system.

Transplant candidates undergo a battery of tests that may include routine blood work, electrocardiogram (ECG) and other radiological and diagnostic procedures.

If accepted as a lung transplant patient, you will join many other patients who are awaiting a transplant. You will be seen on a regular basis to monitor your progress.

As a result of your lung condition, you may have several associated problems that must be addressed. These include:

• Shortness of breath and increased oxygen need
• Decreased activity level
• Wasting of your muscle groups including respiratory muscles, postural or trunk muscles, and your arm and leg muscles
• Cardiovascular deconditioning
• Fear or anxiety due to breathlessness

Evaluation in a pulmonary rehabilitation program is essential if you are considering transplantation. It is important that you be in the best physical shape as possible at the time of your surgery. Lung transplantation will improve your shortness of breath and oxygen need. Therefore, you will be introduced to the importance of exercise and activity before your transplant. This will include training your respiratory muscles as well as a biking or walking program for general conditioning. You will need to continue this program even after your transplant occurs.

After being approved for transplantation, patients are immediately put on the organ donor waiting list. Your placement on the waiting list is determined by the severity of your condition and the likelihood that your transplant would be successful, known as your lung allocation score. Those with higher scores get higher priority when a compatible lung becomes available.

A new lung or lungs will come from a person who is an organ donor. This person has suffered an injury to the blood supply to the brain, which results in “brain death.”

The surgery takes from six to 10 hours, depending on medical conditions. After surgery, you will go to intensive care. From there, your are transferred to a cardiothoracic unit. The expected length of stay for an uncomplicated lung transplant is eight to 21 days.

If you are having a single lung transplant, the incision will be made on your side, either right or left, about six inches below your armpit. Your old lung will be removed through this opening and the new lung will be implanted. In the case of a double lung transplant, the incision will run across the lower part of your chest. The lung, whether single or double, is connected to the pulmonary artery, pulmonary veins and the main stem bronchus or airway. The incisions will be uncomfortable and will take several weeks to heal.

Once your surgery has been completed and the lung transplant is a technical success, the issue of successfully living with a transplant becomes quite involved. The two major issues are rejection and infection.

Rejection is the natural process of your body that recognizes your new lung as being foreign to the body and attempts to destroy it. This reaction originates within your immune system. This is similar to the way your body identifies a splinter in your finger as a foreign object. The redness and inflammation in the area of the splinter is an immune response. To prevent rejection, you must be treated with immunosuppressants, medications that interfere with the body’s normal immune response.

It is expected that you will have episodes of rejection in the first several months after transplant. The treatment requires that you receive doses of the anti-rejection medications intravenously. You will require frequent blood sampling to determine the levels of immunosuppressant drugs, as each individual is unique and requires an individualized approach. The goal is to find the lowest immunosuppressant dose that will prevent rejection and therefore minimize the risk of infection and side effects from the medications. Failure to take these medications will result in the rejection of your new lung.

Because your immune system is suppressed to prevent you from rejecting your new lung, you will be more prone to infection. Your temperature and white blood cell count will be monitored for signs of infection. Infections are generally treated with antibiotics and you will be asked to take certain medications on a regular basis to prevent certain types of infection. You may have to undergo intermittent short courses of intravenous antibiotics. The signs of infection are redness, swelling and tenderness at a surgical site. A new lung infection may begin with a mild fever, new cough and change in lung secretions.

The liver, the largest organ in your body, has many functions including processing proteins, fats and carbohydrates, and breaking down toxic substances such as drugs and alcohol. The liver makes the chemical components that help your blood clot. If the liver fails, you lose the ability to clot blood and process nutrients needed for life.

The liver also excretes a yellow digestive juice called bile, which may accumulate if your liver is not functioning properly. Your eyes may become “jaundiced” or yellow or your skin may itch from the accumulated bile. Some medications help treat the symptoms of liver failure, but there are no drugs that “cure” liver failure.

If your liver begins to fail, you may be eligible for a liver transplant. Liver transplants provide patients a chance for a longer, more active life in the final stages of liver disease or end-stage liver disease.

Because the liver has so many functions, a number of different diseases and conditions can result in liver failure. They include:

• Congenital Liver Damage or Cirrhosis
• Physical and Chemical Changes
• Budd-Chiari Syndrome, a blockage of the veins draining from the liver
• Some liver cancers such as hepatoma and hepatoblastoma
• Fast appearing or fulminant liver failure

A liver transplant may not be recommended if you have an infection outside the liver, a medical condition that poses a problem or if you are an active substance abuser. People who have certain cancers — such as metastatic carcinoma and cancer of the bile ducts called cholangiocarcinoma — or have certain heart or lung conditions are not considered candidates for liver transplant.

In North America there are more than 17,500 patients on the waiting list, with more added each day. Almost 5,000 patients receive transplanted livers every year, but more than 1,700 patients die each year while on the waiting list.

When being evaluated for a liver transplant, a series of tests will be conducted, including:

• Blood tests to help determine how well your liver is functioning, and to assess your kidney function.
• Ultrasound scan to view the blood flow to and from your liver, and locate any abnormal masses in the liver. A probe will be moved over your liver so that its image can be reflected and reviewed on a screen.
• Chest X-ray to help detect infection in your lungs and assess the status of your bones.
• Electrocardiogram to help identify any changes in your heart rhythm.
• Pulmonary function test to measure your lung capacity. You will be asked to breathe into a machine and blood will be drawn to determine how well oxygen is being absorbed from your lungs.

Patients with a history of drug or alcohol dependency are required to remain drug and alcohol free for six months prior to transplant and agree to random screening.

Liver transplantation can be done with a cadaveric donor from someone who has died or by a living donor. To receive a cadaveric donor, you are put on a waiting list until a donor becomes available. This can occur at any time, day or night. The wait is generally two to three years.

A healthy liver has two lobes, one is about 60 percent of the total liver and the other is 40 percent. Either lobe can be transplanted and grow into a full healthy liver for the recipient. A liver donated from a person who has died can be split and used for two recipients. A living person can donate a portion of liver and still maintain liver health.

In living donor liver transplantation, a piece of liver is removed from a living donor and transplanted into a recipient. The procedure, performed after the diseased liver has been removed, is possible because the liver regenerates or grows. The liver’s unique ability to regenerate itself — combined with technological advances — allows more people to be donors.

Regeneration happens over a short period, possibly days to weeks and certainly within eight weeks. When surgeons remove a piece of the donor’s liver, the part that remains grows back quickly to its original size.

Living donors not only reduce the waiting time, but they improve the chance for transplant success. Patients who receive transplants from living donors can better prepare for their surgery, knowing well in advance when the transplant will take place. Also, the liver itself is “fresher” because donor and recipient are in nearby operating rooms and the donated liver portion is transported within minutes.

Donors should be:

• 18 to 55 years of age
• In good health with no major medical or psychiatric illnesses
• A non-smoker for at least six weeks prior to surgery
• Able to understand and comply with instructions for surgery preparation and recovery

Donors cannot be pregnant and cannot be overweight, although overweight candidates who lose weight may be considered.

A living donor doesn’t have to be a blood relative of the liver recipient but you must have a compatible blood type. You must be in good health and be motivated to donate for altruistic reasons. If live donation is a feasible option for a patient, a donor evaluation will be performed after the recipient’s testing is completed.

Once the donor’s blood type is confirmed, they will receive a detailed confidential questionnaire about their family medical history, lifestyle and other information. Tests include:

• Chest X-ray
• Electrocardiogram (EKG or ECG)
• Abdominal ultrasound

After the liver transplant surgery is complete, the patient will go directly to the intensive care unit (ICU), usually for one or two days. When you are ready to leave the ICU, you will be transferred to a care unit in the hospital. Everyone recuperates from liver transplantation differently. Depending on your condition, you will be hospitalized for two to eight weeks following the transplant.

After you are discharged from the hospital, you will be seen in the liver transplant clinic at least once a week for the first month. As you improve, you will be seen less often; eventually, you will be seen once a year.

Laboratory blood tests are obtained twice a week following transplantation. Gradually, the frequency of blood tests will be reduced.

Patients undergoing organ transplantation may face complications. Some possible transplant complications and medication side effects include:

• Hemorrhage
• Thrombosis
• Rejection
• Recurrent disease

Immunosuppressive medications help to prevent and treat rejection. These drugs decrease your body’s resistance to foreign bodies, such as your new liver. You will need to take these medications for the rest of your life or you will reject your liver. Immediately after surgery, the dosages will be high since the probability of rejection is greatest at this time. Dosages will be lowered quickly to smaller amounts if there are no signs of rejection.

The medications you will take for rejection impair your body’s ability to fight off infections. You will be given medication to help prevent infections but you also will need to use caution and avoid contact with people with infections, especially during the first three to six months after transplant.

Most people are born with two kidneys, located behind the abdominal organs and below the rib cage. They perform several important functions including:

• Filtering blood to remove waste products, passing the waste from the body as urine and returning water and chemicals back to the body as necessary
• Regulating blood pressure by releasing several hormones
• Stimulating red blood cell production by releasing the hormone erythropoietin

The kidneys are two bean-shaped organs that produce urine. Urine is carried to the bladder and when the bladder is full, urine is excreted from the bladder through the urethra.

When the kidneys stop working, the condition is referred to as “end-stage renal disease.” Toxic waste products accumulate in the body and either dialysis or a kidney transplant is required to sustain life.

The most common causes of kidney failure include:

• Diabetes mellitus
• Glomerulonephritis
• High blood pressure
• Polycystic kidney disease
• Severe defects of the urinary tract

Treatments for kidney failure are hemodialysis, a mechanical process to clean the blood of waste products; peritoneal dialysis, in which toxins are removed by passing chemical solutions through the abdomen; and kidney transplant. None of these options is a cure for kidney failure. But a transplant offers the best prospects, given that the transplanted kidney functions successfully.

You may qualify for a kidney transplant if:

• You have end-stage renal disease
• You are a child with end-stage renal disease and severe growth retardation

People who are 60 years of age and older are considered for transplant on an individual basis after medical and cardiovascular evaluation. People with anatomically abnormal urinary tracts may not qualify until appropriate reconstructive surgery is completed.

You may not qualify for a kidney transplant if you:

• Recently had cancer
• Recently had a heart attack
• Recently abused drug or alcohol
• Have an active infection

If you qualify for a kidney transplant, you will go through a series of tests to assess your treatment options. You’ll be evaluated for potential medical problems such as heart disease, infections, bladder dysfunction, ulcer disease and obesity.

Regardless of the type of kidney transplant you may undergo — living or cadaveric — special blood tests are needed to determine your blood and tissue type. These test results help match a donor kidney. The tests consist of:

• Blood Type
• Human Leukocyte Antigens (HLA) – tissue typing
• Crossmatch – antibodies
• Serology – potentially transmissible diseases

When the transplant evaluation is complete, you will be placed on a transplant waiting list.

Kidneys for transplant come from a living donor or a deceased (cadaver) donor. When a kidney is transplanted from a living donor, the donor’s remaining kidney enlarges to take over the work of two. As with any major operation, there is a chance of complication. But kidney donors have the same life expectancy, general health and kidney function as others.

Any healthy person can safely donate a kidney. The donor must be in excellent health, well informed about transplantation and able to give informed consent.

If you have a potential living donor, he or she will undergo an evaluation and discuss the possibility of organ donation. Tests will be performed to ensure that the donor and recipient are compatible. In some families, several people are compatible donors. In other families, none are suitable.

The procedure will be described in detail by the surgeon prior to surgery. The operation usually takes three hours. Most patients undergoing laparoscopic surgery for kidney donation require a hospital stay of only two to three days.

After discharge from the hospital, the donor is seen for follow-up care. Donors who undergo laparoscopic surgery often return to work within three to four weeks after the procedure.

A cadaveric kidney comes from a deceased donor. All donors are carefully screened to prevent disease transmission.

If you decide to undergo a cadaveric kidney transplant and you’re medically eligible, your name will be placed on a cadaver waiting list. A blood sample for antibody level will be sent monthly to the medical center. The waiting period for a cadaver kidney depends upon the availability of a cadaver donor compatible with your blood type and your antibody level.

Your surgery may last from two to four hours. During the operation, the kidney is placed in your pelvis rather than the usual kidney location in the back. (Your own kidney will not be removed.) The artery that carries blood to the kidney and the vein that removes blood from it are surgically connected to two blood vessels in the pelvis. The ureter, or tube that carries urine from the kidney to the bladder, is transplanted through an incision in the bladder.

After the operation, you will remain in the recovery room for a few hours and then return to the Kidney Transplant Unit.

You will be encouraged to get out of bed 12 to 24 hours after surgery and walk as much as you can. Nurses will instruct you in taking your medications, explain the side effects and discuss making lifestyle changes.

A cadaver kidney transplant sometimes will be temporarily slow in functioning, a condition called a “sleepy” kidney or acute tubular necrosis (ATN). You may need to undergo dialysis a few times. A “sleepy” kidney usually starts working in two to four weeks.

Most transplant recipients must take medication called immunosuppressants to prevent rejection of the transplanted organ. One of the side effects of these anti-rejection drugs is an increased risk for cancer, particularly skin cancer and lymphoma. You should be closely monitored for these conditions.

An intestinal transplant is a last-resort treatment option for patients with intestinal failure who develop life-threatening complications from total parenteral nutrition (TPN). In intestinal failure, the intestines can’t digest food or absorb the fluids, electrolytes and nutrients essential for life. Patients must receive TPN, which provides liquid nutrition through a catheter or needle inserted into a vein in the arm, groin, neck or chest. Long-term TPN can result in complications including bone disorders, catheter-related infections and liver failure. Over time, TPN also can damage veins used to administer the nutrition via the catheter.

An intestinal transplant may be appropriate if you:

• Are dependent on intravenous TPN
• Have developed infections or complications that make it increasingly difficult to administer TPN
• Have liver failure
• Don’t have a bowel, or have a nonfunctional bowel

After receiving an intestinal transplant, patients can be transitioned from TPN to an oral diet, thus improving their health and quality of life. However, it’s important to remember that an intestinal transplant is not a surgical cure, but rather a last-resort therapy that requires the meticulous administration of medication and close monitoring to be successful.

If you are referred for an intestinal transplant, you will complete an evaluation process to be sure that intestinal transplant is an appropriate treatment for you. During the evaluation process, your medical history will be recorded and you will complete a thorough medical examination and consultations with our doctors, nurses, dieticians and social workers. You also will have a variety of tests, which may include, but are not limited to:

• Upper gastrointestinal and small bowel X-ray series
• Barium enema
• Endoscopy
• Abdominal CT scan
• Motility studies
• EKG and echocardiography
• Ultrasound of the circulatory system
• Blood tests for liver function, electrolytes, kidney function and antibodies to certain viruses
• Additional tests that help determine the success of the transplant

During your evaluation period, the medical team will provide you with detailed information about intestinal transplant and what to expect after surgery. During this time, you’ll have an opportunity to discuss any questions you may have about the procedure.

You also will need to identify a friend or family member as a support person to help you after your transplant. Your support person is very important to your recovery period after you have been discharged from the hospital. They will need to stay with you during this time and accompany you to your follow-up appointments.

If you qualify for an intestinal transplant, you will be placed on the intestinal transplant waiting list. Wait time for all organ transplants depends on the availability of organs and number of people on the waiting list. Intestinal transplant recipients may wait for six months or more to receive a transplant once they are placed on the waiting list.

Care after an intestinal transplant differs slightly for each patient, depending on their medical history, type of transplant and medical condition at the time of their transplant. The length of stay in the hospital varies for each patient, but can last for several weeks or as long as several months.

After your transplant, you will be taken to the intensive care unit (ICU) where you will be closely monitored. When you are ready, you will be transferred to a recovery ward where you will be monitored and cared for by a team of transplant experts, including doctors, nurses and nurse practitioners, dieticians, pharmacists and social workers. During this time, you will have frequent blood draws, biopsies of the transplanted intestine through the ileostomy and radiologic testing. These tests will help determine the health or your transplanted organ.

You also will begin the process of weaning from total parenteral nutrition (TPN) and will slowly start feeding through your feeding tube with a liquid nutritional supplement. Over time, you will start an oral diet.

After you leave the hospital, you can expect weekly office visits, frequent biopsies of the transplanted intestine and lab work twice a week. Your support person also will need to stay with you during this time to help with your daily activities, taking you to testing and medical appointments.

After your transplant, your body will think of the transplanted organ as a “foreigner,” and therefore your immune system will try to attack it. This is called “rejection”. To help prevent rejection from occurring, you will take immunosuppressive medications, which decrease your immune systems activity so that it won’t reject your transplanted organ. The risk of rejection never goes away, so transplant recipients need to take immunosuppressive drugs for life.

Although immunosuppressive medications help reduce your risk of rejection, they also weaken your immune system, putting you at a higher risk for infections. For this reason, you will need to take medications to help prevent bacterial, fungal and viral infections. Some patients also may require blood pressure, diabetes or anti-ulcer medications.

It is important to remember that an intestinal transplant is not a surgical cure, but rather a last-resort therapy that requires meticulous administration of medication and close monitoring to be successful.

Over the last several years, success rates for intestinal transplant have improved dramatically. One-year survival rates for patients after intestinal transplant are more than 85 percent, which is comparable to liver transplant patients. Eighty percent of patients who have had an intestinal transplant are able to completely transition from total parenteral nutrition (TPN) to an oral diet and resume normal activities of daily living.

Transplant recipients face increased risks for cancer such as skin cancer and lymphoma, a side effect of some immunosuppressant drugs, and should be closely monitored for these conditions.

Heart transplantation is the most advanced treatment for end-stage heart disease, the final phase of the disease when there is no effective medical or surgical treatment. The most common procedure is to take a working heart from a recently deceased organ donor and implant it into the patient.

A number of different conditions can damage your heart to the point where other treatments are unsuccessful and a transplant is the best chance for cure. These include:

• Congenital heart disease
• Coronary artery disease
• Heart failure
• Pulmonary hypertension
• Valvular heart disease

Other conditions may exclude a patient from consideration for a transplant, such as irreversible pulmonary hypertension, cancer, HIV, active drug or alcohol addiction, acute mental incompetence and severe muscle loss due to malnutrition, called cardiac cachexia. A number of other conditions are evaluated on an individual basis to determine transplant suitability.

Your heart specialist may ask that you be evaluated for a heart transplant if he or she believes that your heart disease is so advanced that there are no other treatment options and that you would be a good candidate for this surgery.

Once it is determined that you would benefit from transplant surgery, your name will be placed on a waiting list to receive a donor heart. There currently are not enough donor hearts available for the people who need them. Regulations state that hearts must go to the sickest patients first in a given area.

Research currently is being done to evaluate devices that potentially could act as a “bridge” to transplantation by replacing heart function with a machine until a donor heart is available.

The pre-transplant evaluation includes assessment of both the cardiac and extra-cardiac systems. Stable patients usually are able to complete the standard pre-transplant selection protocol on an outpatient basis.

One of the most important components of the cardiac evaluation is an assessment of pulmonary vascular health. If the patient has pulmonary hypertension, it is essential to determine its severity and potential for cure. These trials are conducted in the hospital with right heart catheterization and continuous hemodynamic monitoring often for periods of six to 12 hours.

Additional routine components of the cardiac assessment include:

• Non-invasive studies to evaluate the function of the heart muscle, including echocardiography and radionuclide scans
• Perfusion tests, which measure the amount of blood flow to tissue, including resting and stress radionuclide scans or echocardiography
• The measurement of maximal oxygen uptake during standard exercise studies

Some patients also may need formal cardiac catheterization, including coronary angiography and ventriculography, myocardial biopsy and electrophysiologic studies.

In addition, there are a number of non-heart-related tests and other components that are part of the pre-transplant evaluation, including:

• Pulmonary function testing including spirometry and arterial blood gases
• Lab tests for kidney and liver function
• Interviews with the social worker, transplant coordinator and psychiatrist
• Infectious disease screening including serology and skin testing
• Immunogenetics including blood and tissue typing as well as checking your human leukocyte antigens (HLA) level
• Cancer screening that includes chest X-rays and stools samples for everyone; mammograms, breast and pelvic exams for women; and prostate-specific antigen (PSA) and prostate exams for men

Depending on your specific situation, additional tests may be run during the initial screening.

While the main focus of the evaluation is to determine whether the patient is a suitable candidate for transplantation, the team also works with the patient and family to resolve any potentially reversible conditions such as smoking, drug addition, obesity, mental distress, financial problems and so on.

Patients deemed to be acceptable candidates for transplantation are put on the donor waiting list. Patients may be supported by a variety of medications and devices, including pacemakers, defibrillators and ventricular assistance devices until they can be transplanted.

After the transplant has been performed, the patient is taken into ICU to recover. When they wake up, they will be transferred to a recovery unit in order to be rehabilitated. How long they remain in hospital post-transplant depends on the patient’s general health and how well the new heart is working. Doctors typically like the new recipients to leave hospitals within 1 to 2 weeks after surgery due to a high risk of infection while in a hospital.

Once the patient is released, they will have to return to the hospital for regular check-ups and rehabilitation sessions. They may also require emotional support. As the patient adjusts to their transplant, the number of visits to the hospital will decrease over time. The patient will have to remain on immunosuppressant medication to avoid the possibility of rejection.

Post-operation survival periods now average 15 years.