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PEDIATRIC HEART TRANSPLANTATION
Evaluation process for heart transplant patients

 
   
 

Waiting is hard to do

Once your child has been accepted for a heart transplant, he or she will be placed on a national list of active candidates waiting for donors.

The waiting period may take days, weeks, months or even years and, at times, can be frustrating for patients and family members. Use the resources provided by the Texas Children's Heart Transplant Program, including physicians, transplant coordinators, social workers and chaplains to help you. Asking questions and expressing your thoughts and feelings will help you get through difficult times and keep the lines of communication open between you, your child and your child's caregivers.

Each child who is referred to Texas Children's Heart Transplant Program is thoroughly evaluated by cardiologists and surgeons at the Heart Center. This evaluation period is critical in determining whether a patient needs a heart transplant or will be referred to other programs within the Heart Center for treatment.

 

Upon completion of the medical evaluation, the medical, social and financial information is presented to a medical review board. The responsibility of the board is to review each patient’s case and determine independently and impartially whether he or she is a candidate for transplantation. The members of the board come from many disciplines within the hospital and community at large.

 

The preoperative evaluation involves two to three days of testing, most of which is completed on an outpatient basis. The steps include:

  1. Physical examination and cardiac tests

  2. Cardiologist evaluation

  3. Medical history review

  4. Nutrition planning

  5. Social worker meeting

  6. Spiritual and emotional support

  7. Insurance and paperwork

  8. Additional medical tests for heart transplant candidates

  9. Child-life specialist visit

  10. Dental exam

 

Physical examination and cardiac tests

A cardiologist will perform a physical examination and review the patient's medical records. He or she also will order some or all of the following tests:

  • Echocardiogram: An echocardiogram is an ultrasound that produces pictures of particular areas inside the heart. The pictures will be displayed on a screen and used to study the patient's heart.

  • Electrocardiogram (EKG): An EKG gives a reading based on the electrical activity of the heart, measuring its rhythm and heartbeat.

  • Cardiac catheterization: For this test, a catheter or a thin, plastic tube, is inserted into the heart through an artery or vein in the neck or groin to measure heart pressures and take pictures to further evaluate the patient's heart.

  • Chest X-ray: A chest X-ray takes a picture of the patient's heart and lungs.

Cardiologist evaluation

A heart transplant team cardiologist will review and evaluate the patient's test and overall medical condition to determine whether heart transplantation is medically advisable.

 

Medical history review

Pediatric subspecialists from Texas Children's Infectious Disease and Allergy and Immunology services will review the patient's medical history and study his or her immune system in order to identify and prevent any potential problems.

 

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Nutrition planning

A registered dietitian will evaluate the patient's nutritional habits, measure body fat and muscle mass, evaluate lab tests and create an individualized eating plan to help improve the patient's overall health before surgery. A personalized nutritional plan helps the patient prepare physically for surgery, speed his or her recovery and decrease complications that may arise due to poor nutrition.

 

Social worker meeting

A licensed social worker from Texas Children's Social Services will meet with patients and their families during the initial evaluation and will help with housing and dealing with concerns during the course of treatment.

 

Spiritual and emotional support

For families or patients who request it, chaplains are available to provide spiritual and emotional support.

 

Insurance and paperwork

A business office specialist will assist families with insurance verification and completion of forms needed to obtain approval as well as help with any paperwork that is required for admission to Texas Children's.

 

Additional tests for transplant candidates

If Texas Children's heart transplant team determines the patient is an ideal candidate for heart transplantation, additional information and further testing will be needed. These include blood work, blood and tissue typing and skin testing. This continued evaluation gives the transplant team important information about the patient's overall health and alerts it to any potential issues that may arise.

 

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Child-life specialist visit

A child life specialist is specially trained to meet the developmental and emotional needs of children. He or she will work with the patient and family to "normalize" the transplant experience through play and communication. Child-life specialists also help children learn to cope positively with hospitalization and medical procedures.

 

Dental exam

The patient will need to have a dental exam before being listed for a heart transplant. The dentist should provide Texas Children's with a letter outlining any dental work that is required.

 

 
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