Heart Transplant

A heart transplant is a surgery to replace a sick heart with a healthy one from a donor. Children may need a heart transplant if their own heart is no longer able to pump blood well enough to meet their body’s needs. This can happen because of conditions they are born with, like certain heart defects, or from diseases that damage the heart muscle. A heart transplant is considered when other treatments haven’t worked, and the child’s heart failure is severe. At Children’s Hospital Los Angeles, our Heart Transplant Program team works closely with families to decide the best care plan, always putting the child’s health and future at the center of everything we do.

Before your child can be evaluated for a heart transplant they will need to be referred. Patients are referred to the Heart Transplant Program from a variety of sources. Most patients are referred by their primary care physicians, although some patients refer themselves to the program by calling us directly.

For self-referrals, the patient/family is asked the name of the patient’s attending physician. The patient is also requested to call their primary physician to advise them of their contact with our program. The Transplant Coordinator then begins coordination and communication with the physician.

The physician is forwarded a letter and a packet. The packet contains patient selection criteria and request for laboratory results, medical history, and all necessary materials to complete the evaluation. Additionally, patient management issues are discussed with the physician to assist in determining whether the patient might be an appropriate candidate for evaluation.

Once information about the patient’s condition is obtained and reviewed, the patient may continue the evaluation process, or a decision may be made that the patient does not meet the selection criteria. In either case, the family and referring physician are contacted by phone and follow-up correspondence. They receive a careful explanation of the heart transplant team’s decision.

In some instances, patients may not meet selection criteria at this time but may be eligible for consideration at a later date. In those cases, recommendations may be made to the referring physician regarding the patient’s treatment plan.

If your child is determined to have met the selection criteria and is accepted as a transplant candidate, they will be placed on a national waiting list monitored by the United Network for Organ Sharing (UNOS).

Every effort is made to keep your child in his own environment during the wait for a transplant organ. However, if your child does not reside within two hours of our hospital, you may be asked to relocate closer. Patients may continue to be followed by their primary physicians who then maintain close contact within the program.

Before Heart Transplant Surgery

Patients who are waiting for a transplant are seen by the Heart Transplant Program team every three months or more often if necessary. Your child’s condition is monitored with appropriate laboratory tests performed as needed. During this time period, your child is also being seen on a more frequent basis by their attending physician, and close contact is maintained with the Heart Transplant Program regarding your child’s status.

During Heart Transplant Surgery

When the offer is made and accepted for a donor organ, your child is called immediately and admitted to the hospital for pre-transplant laboratory testing and medications. All medications are administered according to strict protocols.

If your child receives an organ, they are placed in the Cardiothoracic Intensive Care Unit (CTICU) postoperatively. Patients are discharged for rehabilitation from the Cardiothoracic Intensive Care Unit to 6 West, which is a medical surgical unit serving cardiothoracic and transplant patients.

After Heart Transplant Surgery

Upon discharge from the hospital, the Heat Transplant Program team communicates with the patient/family and the referring physician regarding all aspects of the patient’s medical care. The patient/family are taught and must demonstrate understanding of post-transplant medical care requirements prior to departing the hospital. They are given general education materials about what to expect post-transplant, as well as patient-specific materials such as the patient’s medication timetable, and their post-transplant clinic schedule.

Post-Discharge Follow-Up Care

Patients are required to stay near the hospital for two to three months post-transplant. They are seen in the post-transplant clinic on the following schedule:

• Once per week for four visits
• Once every other week for four visits
• Once per month for the first year

Patients are seen by the multidisciplinary team during each visit and are given the opportunity to discuss any problems and receive appropriate laboratory testing.

Post-transplant patients may also be seen at unscheduled times secondary to problems arising following transplant. These patients are seen on a case-by-case basis, and laboratory tests and diagnostic testing are ordered as needed.