Since January 1986, the Transplant Center at Carolinas Medical Center has included one of the busiest cardiac transplant programs in North and South Carolina. More than 390 heart transplants have been performed at the Transplant Center including neonate, pediatric and adult patients.

Despite the pharmacological and surgical advances in the treatment of heart failure, many patients will continue to progress to advanced, end-stage failure. For these patients, cardiac transplantation remains the most effective treatment option.

Heart Transplant Team Members
Patient care is managed by a multidisciplinary team that includes but is not limited to transplant cardiac surgeons, transplant cardiologists, pediatric transplant cardiologists, pediatric cardiologists, pulmonologists, infectious disease specialists, nephrologists, nurse practioners, certified transplant coordinators, medical social workers, insurance coordinators, a pharmacist, and a nutritionist.  

Ventricular Assist Devices
In addition to cardiac transplant, Carolinas Medical Center offers ventricular assist devices (VAD) or mechanical circulatory support as a bridge-to-transplant. In the critically-ill patient awaiting cardiac transplantation, the VAD provides effective hemodynamic support, maintains or improves other organ function, allows for more effective exercise performance and rehabilitation, and provides for discharge to an outpatient setting.

Evaluation Process
Once a referral for cardiac transplant evaluation is received, the patient will be contacted and the evaluation process will be explained. The evaluation process includes but is not limited to:

• Education with a certified transplant coordinator (a teaching session with the patient and primary caregiver)
• Physical evaluation by a cardiologist
• Pyschosocial evaluation with a Masters-prepared social worker
• Transplant financial coordinator evaluation and counseling
• Transplant surgeon evaluation
• Pulmonary evaluation
• Infectious disease evaluation
• Right heart catheterization
• Echocardiogram
• Chest X-ray
• Abdominal ultrasound
• Mixed venous oxygenation consumption study
• Other testing will be ordered based on the patient's medical history.

It is the patient's responsibility to take care of the following:

• Mammogram within 12 months for females over the age of 40
• Pap smear within 12 months for females over the age of 18
• PSA within 12 months for males over the age of 50
• Colonoscopy or flexible sigmoidoscopy for patients over the age of 50
• Dental evaluation within 12 months

Diabetics and ischemic cardiomyopathy patients must undergo further testing, including:

• 24-hour urine for creatinine clearance and protein
• Ankle-arm indices
  Carotid ultrasound
• Opthamology evaluation
• Nephrology evaluation
• Endocrinologist evaluation

Once a cardiac transplant evaluation is completed, the patient is discussed at a multidisciplinary transplant conference and their acceptance as a transplant candidate is determined.

Once a candidate is deemed acceptable for cardiac transplantation and final insurance approval is obtained, the patient is placed on the United Network for Organ Sharing national list. Survival statistics are available at www.ustransplants.org or www.unos.org.

Wait List Maintenance
To remain on the waiting list, patients must complete:

• An office visit with transplant cardiologist every three months or as needed
• Lab work every three months or as needed
• An annual mammogram and gynecologic exam
• An annual prostate examination
• A right heart catheterization every six months

How Organs Are Allocated
Organ allocation guidelines are based on United Network for Organ Sharing and Organ Procurement Transplant Network policies that include medical criteria, as well as the equitable utilization of organs. Specifically, the current heart allocation policy considers characteristics of both the donor and the transplant candidate. A variety of factors determines who receives the organ. These factors include blood type, length of time spent on the waiting list and listing status.

Other Resources
For more information on organ donation and allocation, please visit www.unos.org.

For more information regarding center specific data and statistics, please visit www.ustransplant.org.

For questions about the Heart Transplant Program, please call 704-355-6649 or 800-562-5752.