Heart Transplant Evaluation

Several factors go into heart transplant candidacy. Our goals during the evaluation process are to determine:

• The extent of your heart disease
• The health of your other body systems
• Whether transplant is appropriate for you

You’ll need to undergo a variety of tests to help us achieve these goals. These tests make up your initial transplant evaluation, and they usually span about four days.

Blood and Tissue Tests
These evaluate the function of your kidneys, liver, and immune system; determine your blood type for a donor match; look for evidence of past viral exposure; and more. You can expect multiple blood draws.

Left and Right Heart Catheterizations
These minimally invasive procedures can be done together or separately. While you are lying down, an interventional cardiologist will numb an area of your skin and insert a small tube (called a catheter) into a blood vessel in your arm or groin. The catheter will be guided into your heart to take detailed assessments of the pressures and blood flow inside your heart, and to take pictures of your coronary arteries (which supply blood to the heart itself).

Cardiopulmonary Exercise (CPX) Test
This type of test helps determine your heart and lung performance during exertion. You will be asked to perform mild exercise, usually on a stationary bicycle or treadmill, while your vitals are monitored. You’ll breathe through a mouthpiece while electrodes attached to your chest record your heart’s electrical activity (this is called an electrocardiogram, ECG, or EKG). 

Imaging
A series of imaging scans will give your doctor detailed pictures of your organs, blood vessels, and other vital structures. All of these scans are noninvasive and are virtually painless.

• A ventilation-perfusion (V/Q) scan looks for evidence of blood clots in the lungs.
• An echocardiogram evaluates your heart’s valves. It also measures your heart’s ability to pump blood throughout the body by measuring the ejection fraction -- the percentage of blood that leaves your heart each time it contracts.
• Ultrasound imaging of your neck checks for blockages or narrowing in your carotid artery, which carries blood and nutrients to your brain. You may also have an ultrasound of your liver and gallbladder to check for gallstones, inflammation, or duct obstructions.
• A chest CT scan determines whether there is scarring in the lungs and where your heart is relative to your chest bone. 

Pulmonary Function Testing
Several tests measure how well your lungs take in and expel air, and how well they move oxygen into your bloodstream. You’ll be asked to breathe into a spirometer, which is a mouthpiece connected to a machine that records your results.

Arterial Brachial Index (ABI)
This test is a quick and easy screen for peripheral artery disease (PAD). It compares the blood pressure measured at your ankle with the blood pressure measured at your arm. 

Routine Health Maintenance Testing
Routine tests like colonoscopies, PAP smears, mammograms, tuberculosis tests, and dental exams help doctors get a better sense of your overall health. Some of these are only required if you haven’t had one recently.

Psychosocial Evaluation
A specialized psychologist and a social worker will meet with you to discuss your family life, social habits, employment, finances, substance abuse history, mental health, and legal history. They will ask whether you have a support system in place for your post-transplant care. You’ll also be asked to complete questionnaires to help assess your ability to adjust to life after heart transplantation.

After the heart transplant evaluation is complete, the entire heart transplant team meets to discuss your results and determine whether a heart transplant should be your next step. If your team recommends transplant, you will be officially placed on the United Network of Organ Sharing (UNOS) national waitlist.

Step 2: Waiting for a Heart