Multi-Organ Transplant

Heart Transplant - Patient Information

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The Heart Transplant program began in 1985, and was first performed at the Toronto Western site of the University Health Network. Since that time, over 280 heart transplants have been performed, with heart-lung transplantation added to our services in 1997. Each year the MOT team performs about 20 heart transplants, while approximately 35 patients with cardiac failure are supported on the waiting list.

Indications
The causes of end-stage heart disease vary. Patients under consideration for heart transplant present with a variety of cardiomyopathies due to hereditary birth defects, viruses, or ischemic cardiomypathy. These conditions cannot be improved by medication or surgery. Heart transplantation offers patients the potential of living independent, active lives.

Assessment
Pre-transplant evaluation consists of a variety of medical tests and interviews with members of the transplant team. This process is essential in determining a patient's suitability for heart transplant. During the evaluation process the potential candidates and their family will be provided with information to assist them in making informed decisions about the operation and post-operative period. The patient and their family are encouraged to ask questions of the team members and meet the candidates awaiting transplant as well as those already having received a heart transplant.

The workup process typically involves the following tests, but may require additional testing if other health issues are of concern:

	Pulmonary Function Tests
	Chest X-Ray
	Abominal Ultrasound
	CT Scan of Chest
	Bone density scan
	Coronary Bloodwork
	ECG
	Hemodynamic monitoring
	2D Echo with Doppler
	Angiogram
	Thallium Persantine Scan
	Urine tests

The Transplant Team Members who consult on heart transplant evaluation are:

	Cardiologist
	Anesthetist
	Transplant Coordinator
	Social Worker
	Psychiatrist / Psychiatric Nurse
	Physiotherapist
	Occupational Therapist
	Nutritionist
	A member of the Heart Transplant Mentor program

Waiting List
Once accepted as a heart transplant candidate, we suggest that patients live within the greater Toronto area to facilitate access to the transplant team for ongoing monitoring, support and education, as well as ready availability when called for transplant. Under some circumstances, if a patient lives a distance from the Toronto area the team may be willing to allow the patient to remain in their home and will arrange to bring in by air transport. Patients are informed that this cannot be guaranteed and may result in an alternate patient being called if transport is not available at that time.

Surgery
Heart transplant surgery may last anywhere from 3 to 5 hours. The following is a brief description of the surgical process for heart transplantation.

Once the donor heart is determined to be suitable, patients are taken to the operating room and placed under anaesthetic. Patients are then placed on cardiopulmonary bypass while the surgeon works to remove most of the recipient heart. The posterior walls of both atria are left in place and the new heart is attached to this remaining tissue. Since the new heart will be denervated (nerves cut), pacemaker wires are set in place as a precautionary measure. These wires can be connected to an external pacemaker if necessary, and will be removed 10-14 days after transplantation. The chest is then closed and the patient is taken to the Cardiovascular Intensive Care Unit (CVICU) for the initial recovery period.

Recovery
Heart transplant recipients can expect to be in the hospital for approximately one week after surgery. After the transplant procedure, patients are closely monitored in the CVICU. Post operatively patients are assisted with breathing through a ventilator. Once stabilized, the ventilator is removed and the patient is then transferred to the Multi Organ Transplant Unit. Patient care following transplantation focuses on:

	Monitoring for Rejection
	Adjusting Immunosuppressive Therapy
	Education and Teaching
	Rehabilitation
	Support

Discharge & Follow-up
Discharge planning begins well in advance and patients meet with a social worker during their initial assessment to address these issues early. Patients most commonly continue living in Toronto for about three months, until their transplant has stabilized. The program's Patient Resource Coordinator assists in assessing patients' readiness for discharge and ensuring patient teaching is complete.

Patients will return to Ambulatory Care regularly after the initial postoperative period, with the frequency of clinic visits reduced as the patient's condition permits. During clinic appointments, their Transplant Coordinator, Transplant Cardiologist, and Primary Care Nurse Practitioner see patients. Communication with the patient's family physician and other specialists is an important component of follow-up care. Patients keep in contact with their transplant team through our patient voicemail system, Easy Call.

The Multi-Organ Transplant Program's team approach ensures that patients receive comprehensive follow-up care after transplantation and throughout their lives post-transplant.

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