Penn Heart Transplantation Program
Over 640 hearts.
That’s how many hearts the Heart
Failure and Transplantation program at the
Hospital of the University of Pennsylvania has
transplanted since opening in 1987. Surgeons at
the Penn
Transplant Center have transplanted approximately
50 people every year for the past five years.
It is one of the largest programs in the country
performing more heart transplants that any other
hospital in the Philadelphia region and state
of Pennsylvania (Organ and Transplant Network,
2004).
How a Decision is Made
Patients referred to the cardiac specialists
at the Heart Failure and Transplantation program
usually have serious cardiac disease. Less than
20 percent of the patients referred to our program
proceed to a heart transplant evaluation.
If a cardiologist considers a patient’s
heart very weak, the patient is recommended for
a heart transplant evaluation.
An evaluation for a heart transplant includes:
- Interviews
- Blood tests
- Cardiac testing including
- echocardiogram
- electrocardiogram (EKG)
- exercise stress test
- right heart catheterization
Additional testing to evaluate the rest of the
body includes:
- Chest X- ray
- Abdominal ultrasound
- Vascular studies
- Pulmonary function tests
- Blood tests for the kidneys, liver and immune
system
The doctors and nurses examine a patient’s
current health, history of immunizations, dental
records and current lifestyle including history
of smoking, drugs or alcohol.
The patient and family meet with a social worker,
financial counselor, transplant nurse practitioner
and the doctors to discuss the implications of
undergoing heart transplantation.
Donna Chojnowski, clinical manager of the Heart
Failure and Transplantation program, says patients
may not always realize the difficult road that
lies ahead.
“Patients need to know that they must take
lifelong anti-rejection drugs to survive with
a transplant. The tradeoff is the risk from the
side effects of these drugs such as infections,
kidney disease, liver problems and high blood
pressure.”
Each patient has a heart transplant team made
up of a surgeon, cardiologists, transplant nurses,
infectious disease doctors, social workers, nutritionist
and financial counselor.
This team looks at the patient’s case and
asks the following questions:
- Is the patient sick enough to get a
new heart?
- Does the patient have any medical issues
that would impair the quality of life after the
transplant?
- Does the patient have a stable support system
in place to help through the process?
In some cases the patient may not benefit from
a heart transplant and the team discusses other
options.
All Systems are a Go
If the decision by the team is that the patient
is a good candidate for a heart transplant, and
the patients agrees, the patient is entered into
the national waiting list at the United Network
of Organ Sharing (UNOS). This waiting list has
information about each patient’s blood type,
body size, clinical status and date listed.
A heart generally goes to the sickest patient
who has been waiting the longest. Factors such
as body size, blood type, donor age and geographic
location also play a part in who gets a heart
first.
Patients waiting on this list are categorized
in three different ways based on the severity
of their current situation.
Status 1A - Patients in the hospital that require
support from a cardiac-assist device or ventilator
or certain continuous cardiac intravenous medications
and a catheter to measure heart function.
Status 1B - Patients requiring the support of
a cardiac-assist device or continuous intravenous
cardiac medication and are at home or in the hospital.
Status 2 - All other patients.
A patient’s status may change while on
the list depending on his or her condition. For
example, some patients start at the urgent status
and may improve to wait at home so the status
would change to status 1B. Another patient could
get sicker and move to a 1A. Patients are continually
monitored by the heart transplant team, in partnership
with a cardiologist, while on the list.
The Waiting Period
A patient waiting for a heart can wait for as
little as a few hours or as long as a few years.
As this patient waits, he or she may need continuous
intravenous cardiac medication or have a cardiac-assist
device called a Ventricular Assist Device (VAD).
While waiting, patients are encouraged to stay
as active as possible, keep taking the prescribed
medications and maintain a healthy diet.
“Once a donor heart becomes available,
the transplant surgeon and transplant nurse practitioner
make the calls to coordinate the patient and team”,
says Chojnowski. “The transplant surgery
itself is 3 to 4 hours long—but the time
it takes to coordinate and get the donor heart
may be longer. Traffic, weather, and location
can all affect the time it takes to get a donor
heart to the patient.”
Time is of the essence in a heart transplant.
The donor heart has four hours from the time it
is surgically removed from the donor to the time
it is implanted in the recipient, before it begins
to deteriorate. This is why geographic location
plays a role in who gets a heart.
After the transplant surgery, patients are taken
to the intensive care unit (ICU) and then to the
“step down” unit where they will remain
to recover and rehabilitate for 10 to 14 days.
The Experience
Receiving a heart can be both a physical and
emotional experience.
“At first, patients are just happy…their
mood is elevated,” comments Chojnowski.
Organs begin to work better as they get more oxygen-rich
blood. Patients begin to recover and feel good
again.
As time goes on, however, many patients come
to the realization that they are alive because
someone else has died.
“It can be an additional burden,”
says Chojnowski, “Some patients get motivated
and make extra efforts to take care of themselves.
Other patients may need more emotional support
along the way.”
Patients who have received a heart are encouraged
to write a thank you note to their donor’s
family. The Gift of Life program works with families
of organ donors and transplant recipients to facilitate
communication and support.
Success
So what is a successful heart transplant?
“A success is a patient who survives and
has a good quality of life after the transplant,”
says Chojnowski. Though a patient has an opportunity
at a new chance of life, they know that it is
not an easy road ahead.
The multidisciplinary staff of the Heart Failure
and Transplant Program at the Hospital of the
University of Pennsylvania assists in the management
of the heart transplant recipients throughout
their life. The social workers and financial counselors
are available for guidance and support to guide
them as they face new obstacles. A peer support
group meets to discuss the issues they face and
help each other along the way.
“We want patients to leave here knowing
they have a second chance,” says Chojnowski,
“So they can get back to the life they once
had.”
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