Referrals for possible intestinal transplant evaluation can be initiated from several sources. They are typically received from a local physician, case manager, or from the patients themselves. Time is spent over the phone discussing the medical condition of the potential transplant candidate and medical records will be requested. Once these records are reviewed and it is decided that an intestinal transplant evaluation is indicated, an insurance review is conducted. Once appointments are arranged, a packet will be sent via mail which will include a schedule of appointments, a map of Cleveland Clinic’s campus, housing information, and education materials.
An intestinal transplant evaluation usually requires up to two weeks of outpatient testing. Appointments are generally scheduled as soon as possible, prioritized by medical urgency. Your evaluation will consist of several consultations, lab tests, and various imaging studies.
The informed consent process begins during the pre-transplant evaluation and continues throughout the entire transplant process. You will be educated by the Intestinal Rehabilitation and Transplant Team regarding the evaluation process, transplant procedure, postoperative care (including need for lifelong immunosuppression), and potential complications. You will be scheduled for the following consults and appointments during your transplant evaluation:
- The Transplant Nurse Coordinator will provide education regarding the transplant evaluation process, listing criteria and process for transplant as well as patient responsibilities before and after transplant. This meeting is intended to provide you with an opportunity to ask questions and to become fully informed about the intestinal transplant process.
- The Intestinal Rehabilitation and Transplant Physicians/Gastroenterologists and Dietitians are professionals who specialize in intestinal failure. Their function is to assist in the medical evaluation and treatment of the underlying intestinal disease and assess your ability to respond to medical and dietary intervention. The physicians and dietitians also work with the transplant team to determine if you are medically suitable and nutritionally optimized for an intestinal transplant. These professionals have the expertise needed to manage nutrition for pre- and post-transplant patients, provide information and education on nutrition therapy and ease the transition to tolerance of a full oral diet.
- An Intestinal Transplant Surgeon will meet with you and discuss the appropriateness of a transplant based on the information obtained during your evaluation. The surgeon will also discuss the significance of undertaking an intestinal transplant, the various types of intestinal transplant, the risks and benefits of the surgery, and the possible complications after your transplant.
- An Anesthesiologist consult will be scheduled to determine the care required to provide safe administration of general anesthesia during your transplant surgery. Your records will be reviewed and additional testing may be recommended if indicated.
- A Transplant Social Worker conducts a thorough assessment of your support system, compliance history, and motivation for intestinal transplantation. Your ability to cope with the stress of the transplant process and ability to follow a rigorous treatment plan both before and after transplantation will be discussed. Recommendations regarding support resources available will be made as indicated.
- A Financial Counselor will discuss the coverage plan you have in place, the costs associated with your transplant, and the cost of the medications you will require. They will work with you to understand your insurance coverage and/or options to obtain or maintain coverage.
- A Psychiatrist will conduct an in-depth psychiatric evaluation and assessment.
Sometimes, referrals will be made to other specialized services for consultation. For example, appointments may be necessary with renal, pulmonary or cardiology specialists to assess possible co-morbidities and optimize clinical conditions before transplant surgery occurs. All patients must undergo imaging studies to describe the individual anatomy of the gastro-intestinal tract. This is extremely important to determine the type of transplant needed. Given the incidence of venous access thrombosis with prolonged parenteral nutrition, candidates for intestinal transplant will need an accurate “mapping” of major vascular access available in the body. This is assessed by performing a vascular access study. If necessary, in selected situations, interventional radiology may be consulted for additional pre-operative vascular access assessment.
- Labwork is required during the transplant evaluation and is determined by individual need of the potential intestinal transplant candidate.