A heart transplant is only done when it is absolutely necessary and likely to have long-term success. The process of getting accepted into Cleveland Clinic’s heart transplant program involves several steps to ensure the best possible outcomes for every patient.
Step 1: Referral to the program
There are two ways to be referred to Cleveland Clinic’s heart transplant program – by your doctor or you can refer yourself.
To start the referral process, call the pre-transplant office at: 216.444.8351 or toll-free 800.223.2273 ext. 48351.
Step 2: Transplant Evaluation
Every patient interested in a heart transplant must have a comprehensive evaluation. The evaluation is done to find out exactly how advanced your heart disease is and to create the best plan of care for you. The evaluation takes 3 to 4 days and includes tests and procedures, meeting the members of the transplant team and getting information about all possible medical and surgical treatment options, including heart transplant.
The team members will talk to you about many aspects of heart transplantation, including:
- How patients are selected for the heart transplant program
- Your support system and any issues that may affect your ability to be selected for a transplant
- Financial responsibilities associated with a transplant
- The importance of following your plan of care before and after your transplant
Tests that you may have during your evaluation include:
- Blood tests
- Chest X-ray
- Urine test
- Echocardiogram (echo)
- Cardiac stress test
- CT scan
- Right heart catheterization
- Pulmonary function test
- General health screening
- Psychosocial evaluation
You will get detailed information about your evaluation and the testing after they are scheduled. After you complete your evaluation, your test results and other information will be reviewed by a committee to determine if you are a good candidate for a heart transplant and in need of one at this time. If you are accepted into Cleveland Clinic’s heart transplant program, your information will be forwarded to the Ohio Solid Organ Transplant Consortium (OSOTC) for approval. Your insurance company must also approve the transplant. After you are fully approved for a transplant, you will be placed on the United Network for Organ Sharing (UNOS) national waiting list.
Step 3: Waiting for transplant
Being placed on the UNOS waiting list does not guarantee you will get a heart transplant. It is critical that you follow your plan of care and do not miss any follow-up appointments.
The organs used for transplant are based on criteria from UNOS and include:
- How sick you are
- How long you have been waiting for a transplant
- Your height and weight
- Your blood type
Step 4: Getting a transplant
The heart transplant national allocation system is based on medical urgency and currently has 6 active tiers. The first 3 tiers are the most urgent and usually require hospitalization and life support while the other tiers are for more stable patients. Details of each tier are below.
- Venous-arterial Extracorporeal Membrane Oxygenation (VA ECMO)
- Surgically implanted, non-endovascular Biventricular assist device (Bi-VAD)
- Mechanical circulatory support (MCS) with ventricular arrhythmias
- Surgically implanted, non-endovascular left ventricular assist device (LVAD)
- Intra-aortic balloon pump (IABP)
- Ventricular arrhythmias requiring electrical cardioversion despite IV antiarrhythmics
- MCS with device malfunction/failure
- Total artificial heart, Bi-VAD, right ventricular assist device, or ventricular assist device for single ventricle pts.
- Percutaneous endovascular MCS
- Outpatient LVAD for 30 days
- Multiple inotropes or single high-dose inotrope with hemodynamic monitoring
- VA ECMO after 7 days; percutaneous endovascular MCS or IABP after 14 days
- Surgically implanted, non-endovascular LVAD after 14 days (hospitalized)
- MCS with one of the following:
- device infection
- pump thrombosis
- right heart failure
- mucosal bleeding
- aortic insufficiency
- Outpatient LVAD
- Inotropes without hemodynamic monitoring
- Diagnosis of one of the following:
- Congenital heart disease
- Ischemic heart disease with intractable angina
- Hypertrophic cardiomyopathy
- Restrictive cardiomyopathy
- Mucosal bleeding
- On the waitlist for at least one other organ at the same hospital
- All remaining active candidates
Step 5: After your transplant
Your recovery in the hospital
You will stay in the hospital about 12 days after your heart transplant. Your stay may be shorter or longer, depending on how quickly you recover. Your recovery starts in a cardiovascular intensive care unit (CVICU), where you will be closely monitored around the clock. You will complete your recovery on a special heart transplant patient recovery floor.
Your recovery after you leave the hospital
The goal of your recovery is to have an active life; however you will need to limit some activities as you continue your recovery at home. Your doctor will talk to you about these restrictions and when you will be able to get back to a normal routine.
You will have regular follow-up appointments, testing and biopsies to check for any signs of organ rejection, infection or other problems. If you do have a problem, you may need to have more frequent visits or be admitted to the hospital for treatment or surgery.
Following your plan of care
The success of your transplant depends very heavily on how well you follow your plan of care. This includes:
- Taking all medications exactly as prescribed
- Keeping all follow-up appointments
- Having blood tests or other tests on time
- Following your recommended diet and fluid guidelines
- Following your activity guidelines
- Following all other medical advice and instructions from your transplant team
- Contacting your post-transplant coordinator right away is you have any issues or concerns
Your risk of infection and cancer are higher after a heart transplant because one of the medications you need to take weakens your immune system. It is important to avoid being around people who have an infection and to call your doctor right away if you have any signs of infection. Your doctor will talk to you about what these signs and symptoms are.
Heart Transplant Rejection
Organ rejection is one of the risks of a heart transplant procedure. It is possible that your body will reject your new heart right away or over time. Regular biopsies and follow-up visits help your transplant team know if there are any signs of organ rejection. Your doctor will talk to you about the different types of rejection and the appropriate treatments for each. If your new heart is not expected to work, you may be placed back on the waiting list for a new heart.