You will have a thorough evaluation of your medical condition so that the Texas Heart Institute at St. Luke's Episcopal Hospital transplant team can assess the specific risks and benefits of cardiac transplantation for you. The various medical team members will gather data, give you specific information, and answer your questions. The results of this medical work-up will help the team in making decisions about your suitability as a candidate for transplantation.

The pre-operative evaluation requires four to five days of testing, most of which is done on an outpatient basis. Generally, the process follows these steps:

1. Physical Examination and Cardiac Diagnostic

First the cardiologist will perform a thorough physical examination and review the medical records you have brought with you or which have been sent to us. In addition, he or she will order some or all of the cardiac tests listed below:

Echocardiogram - an echocardiogram uses an ultrasonic device to produce pictures of particular areas inside the heart. The pictures, which are displayed on a screen, are used to study your heart.

Electrocardiogram (EKG or ECG) - the EKG gives a readout based on the electrical activity of your heart, measuring the rhythm and regularity of your heartbeat.

Stress Test - a stress test measures the endurance capability of your heart at rest, at peak stress, and after exercise. Most stress evaluations are carried out while the patient walks or jogs on a treadmill.

Left Ventricular Performance Study (LVPS)  - the LVPS is a noninvasive (non-surgical) cardiac test that measures the pumping capability of the left ventricle of your heart. This study is also referred to as a gated blood pool scan or as a multi-unit gated analysis (MUGA) scan.

Cardiac Catheterization - in this test, a catheter (thin plastic tube) is inserted into the heart through an artery in the neck or groin to detect blocked arteries, valve disease, and other heart problems.

2. Your Cardiologist's Decision

Your cardiologist will evaluate your condition at this point and decide if transplantation is medically advisable.

3. Medical History Review

Medical staff members from Infectious Disease will review your past medical problems and study your immune system. The information they obtain will help them predict problems you might encounter and prevent problems that could affect your recovery. Specialists in lung problems, kidney problems, and psychiatry are also available, if needed.

4. Nutritional Plan

A dietitian will evaluate your current nutritional status. He or she will ask you to describe your eating habits before you came to the hospital, including any problems you had or special diets you followed. The dietitian will measure your body fat and muscle mass and evaluate your lab tests.

Then he or she will set up an individual diet plan with recommendations for improving your diet and your overall physical condition before surgery. The goal of this nutritional plan is to help prepare you for surgery, to make your recovery faster, and to decrease the number of complications that could result from poor nutrition.

5. Social Services Evaluation

A clinical social worker from Social Services will meet with you and your family during your initial evaluation to gather information about your experiences since your illness began, including its effects on your lifestyle, personal relationships, job, and financial status.

The social worker will also be available later to offer help with the many problems you may have during the course of treatment, from finding housing to dealing with emotional problems.

6. Spiritual and Emotional Support

For those who request it, chaplains from St. Luke's Pastoral Care are available to provide spiritual and emotional support.

7. Insurance and Paperwork

A representative from the hospital's Business Office will help with insurance verification and filling out any forms necessary for insurance approval. He or she will also let you know if you need to pay a deposit on admission to the hospital. This deposit will depend on your health insurance, the kind of medical care you need, and your expected length of stay. Finally, the representative will take care of all paperwork necessary for your admission to the hospital. Your social worker can also provide information on costs and methods of payment.

8. Additional Tests for Transplant Candidates

If the medical staff determines that your condition makes you a serious candidate for transplantation, additional information will be needed. This continued evaluation gives the Transplant Team important information about your overall health and alerts them to any other medical problems you may have.

Blood Work - helps reveal the condition of all your organ systems, such as your kidney and liver.

Tissue Typing - helps the Transplant Team find a donor heart that matches your own. This procedure also provides valuable information about your body's immune system.

Upper and Lower Gastrointestinal (GI) Series - involves bowel preparation and cleaning, followed by several x-rays to evaluate your esophagus, stomach, intestines, and colon. The purpose is to identify possible ulcers, polyps, gallstones, pancreatitis, or diverticulosis.

Skin Testing - to determine if you have been exposed to infections such as tuberculosis.

Gynecological Exam for Women - necessary for women who have not had an exam in the six months prior to surgery.

Pulmonary Function Studies - if you have a history of lung disease or tobacco use, your transplant work-up will include pulmonary (lung) function studies.