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Before Transplant (Evaluation) |
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Before Transplant (Evaluation) |
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An extensive evaluation must be completed in order to determine whether heart transplant is the right therapy for your child, and whether it is right for your family. This testing includes:
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- blood tests
- diagnostic tests
- psychological and social evaluation of the child, if he or she is old enough, and the family
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These tests are done in order to gather the correct information to help determine how urgent it is for your child to be placed on the transplant list, and to make sure that the child receives a donor organ that is the right match.
These tests evaluate all aspects of your child's health including:
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- complete cardiac evaluation
- complete assessment of all other systems including
- gastrointestinal (liver, pancreas, nutrition, gut)
- immune/Infection (immunization history, prior infections)
- blood type assessment
- Each person has a specific blood type: type A+, A-, B+, B-, AB+, AB-, O+ or O-. When receiving a transfusion, the blood received must be a compatible type with your child's blood type, or an allergic reaction will occur. The same reaction will occur if the blood contained within a donor organ enters your child's body during a transplant. Allergic reactions can be avoided by matching the blood type of your child and the donor.
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Diagnostic tests that are performed are extensive, but necessary, to understand the complete medical status of your child. The following are some of the other tests that will be performed, most often decided on an individual basis.
Diagnostic Tests:
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- Blood tests.
- Urine tests.
- Echocardiogram — A procedure that evaluates the structure and function of the heart by using sound waves recorded on an electronic sensor, that produce a moving picture of the heart and the heart valves.
- Electrocardiogram (ECG or EKG) — A test that records the electrical activity of the heart, shows abnormal rhythms (such as arrhythmias) and detects heart muscle damage.
- Cardiac catheterization — A procedure in which a small, thin tube, called a catheter, is guided through a vein or artery into the heart in order to view the heart and blood vessels. An iodine compound, which is a colorless, liquid dye, is given through the catheter, so that moving x-ray pictures are made as the dye travels through the heart.
- Heart Biopsy — A procedure that takes a small tissue sample of heart muscle for examination and testing to attempt to understand why the heart does not work.
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In order to determine whether your child is a good candidate for heart transplantation, the transplant team evaluates all of your child's information, including:
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- interviews
- medical history
- physical examination
- diagnostiic tests
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If accepted by the team, and once the family is fully educated about the risks and benefits, your child will be placed on the United Network Organ Sharing (UNOS) list.
During the evaluation process, you and your child will be interviewed by many members of the transplant team. The following are some of the members of the team:
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- Transplant surgeons — Pediatric heart surgeons who specialize in transplant surgery and who will be performing the surgery.
- Transplant cardiologists — Pediatric cardiologists who specialize in the medical evaluation and treatment of end-stage heart disease and transplant.
- Pulmonologists — Physicians that specialize in the function and disease of the lungs.
- Transplant nurse coordinator — A pediatric cardiac nurse or nurse practicioner who organizes all aspects of care provided to your child before and after the transplant. The transplant coordinator will provide patient education and coordinate the diagnostic testing and follow-up care.
- Social workers — As members of the multidisciplinary health care team, clinical social workers are trained, licensed professionals who provide a spectrum of psychosocial services that enhance the quality of care for children and their families before and after the transplant. They provide emotional support, counseling and referrals to meet individual family needs.
- Nutritionists — Professionals who will work closely with you and your family to help your child meet his or her nutritional needs before and after the transplant.
- Physical therapists — Professionals who will help your child become strong and independent with movement and endurance after the transplantation.
- Pastoral care — Chaplains who provide spiritual care and support.
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There is no definite answer to this question. Sometimes, children wait a few days or weeks before receiving a donor organ. It may also take months or years on the waiting list before a donor organ that is a good match is available. During this waiting period, your child will have close follow-up with his or her physician and the transplant team. Various support groups also are available to assist you during this time. Some children must wait in the hospital for their new heart.
A major problem affecting the availability of hearts for transplant is that these organs cannot come from living donors. Kidney transplants often come from a living donor, and both the person who donates the kidney and the recipient of the kidney are able to live with one remaining kidney. New techniques are making it possible for some people in need of a liver transplant to receive part of an organ from a living donor, as both the recipient and the donor are able to live successfully with just a segment of a liver.
Neither donor nor recipient can live with only a segment of a heart. Therefore, people in need of a heart transplant must wait for the death of a person who generously decided to share his or her organs.
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Availability of donors for heart transplantation is affected by the size of the child needing the transplant. For instance, an adult donor heart cannot be transplanted into an infant, because the infant's chest is simply too small to hold the larger heart. Children must usually wait for an appropriately sized organ to become available.
However, as of May 15, 2000, new UNOS guidelines were established to give preference to children under the age of 18 on the waiting list, before adults, whenever a heart from an adolescent donor (aged 11 to 17) becomes available.
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