Assessment for transplant

 

Workup for transplant

 

Transplantation of any organ is a complex procedure with significant risks. Many tests and investigations will need to be completed before it is decided whether it is the best option to proceed with a transplant.

 

During your assessment you will meet many members of the team including:

  • Physicians (Cardiologists or Respiratory Physicians)

  • Surgeons

  • Social Worker/Counsellor

  • Clinical Psychologist

  • Physiotherapist

  • Dietician

  • Nursing Staff

  • Transplant Coordinator

The assessments tests assess not only your heart and lungs but many aspects of your health and body.  It may be possible for the tests to be performed as either an inpatient or outpatient.  Your transplant team will discuss with you the best option for having the tests completed.

 

Some of the tests required include:

  • Height and weight

  • Vital signs  - (temperature, pulse, blood pressure, oxygen saturation etc)

  • Blood tests, urine, and sputum sample collection

  • Chest X-ray - While this is a simple test that you would have had many times, it allows us to ensure you have no obvious infection or changes that have not been treated.

  • Lung function tests - Measures the function, capacity and condition of your lungs. It also allows us to determine any deterioration in lung function.

  • Renal tests (GFR) - This scan assesses your kidney function, you will receive an injection and then blood samples are collected for up to five hours to see how well your kidneys clear the injected substance.

  • 12 Lead electrocardiograph (ECG) - A recording of your hearts rhythm.

  • Echocardiogram of the heart - The ultrasound of the heart determines the size and pumping strength of all structures of the heart including heart valves and muscle.

  • Chest CT scan  - A scan of detailed images of your lungs and chest structures.

  • Ventilation-perfusion scan -  Is a type of imaging used to determine the supply of air and blood within your lungs.

  • Bone mineral densitometry -  Measures the density of your bones and shows whether you are at risk of developing osteoporosis.

  • Angiogram  -This test is not performed for everyone and if required will usually be the last test. If you are not an inpatient, you will need to be admitted for a day. The test assesses the arteries that supply the heart muscle looking for any blockages or narrowing. The pressures and function of the heart are also assessed and if necessary the pressures in the lungs can be measured.

 

As a result of these tests more specific investigations may be required. If you have any pre-existing illnesses these will also be investigated and may require further treatment. Other specialists may also become involved in your care if necessary.

 

Prior to any transplant consideration, your vaccination status will be checked and updated as required to ensure appropriate protection. Common vaccinations that may be required if you have inadequate immunity include;

            Measles, Mump, Rubella and Varicella Zoster (chicken pox)

            Hepatitis A and B

            Annual Influenza vaccine

            Pneumococcal vaccination

 

Suitability for transplantation

After all of these tests have been performed and the results finalised, your case will be reviewed at a transplant multidisciplinary team meeting. The transplant team will make a decision to either:

A.         perform more tests to further investigate your health before a final decision is or can be made

B.         suggest alternative treatment options other than lung transplantation if possible

C.         maximise your current condition and continue to monitor your health with the view of possibly listing you for transplantation in the future

D.         accept you for lung transplantation and place you on the transplant waiting list.

 

The transplant physician will discuss all the treatment options available. It is strongly recommended that you be accompanied by a family member or friend for this appointment.

 

Unfortunately, transplantation is not the best treatment option for everyone. If you have a condition that significantly increases the risks of the operation or may limit your survival after surgery, transplantation may not be considered suitable. Continued smoking or significant alcohol intake, for example, will prevent you being considered for transplantation.  

 

Some patients, once they have had all the investigations and education, do not wish to have a transplant. This is a decision that only you can make. It is important to have gathered enough information and speak with as many people as possible before making this decision. If it would help, it is possible for you to meet someone who has had a transplant. This final decision should be made following detailed discussion with your treating physician and the transplant team.

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