If, after this initial evaluation, transplantation is felt to be the only alternative to provide a reasonable chance of long term survival and quality of life, a full transplant evaluation is performed. Noninvasive and laboratory testing is performed to assess pulmonary, renal, hepatic, cerebrovascular, and peripheral vascular disease. Flexible sigmoidoscopy, stool guaiacs, prostate specific antigen, mammograms and gynecological examinations are obtained to rule out common malignancies. A psychosocial evaluation is performed by the program social worker to assess the adequacy of family support systems, financial resources, history of substance abuse, and probability of future medical compliance. If there is any suggestion of a significant psychiatric condition, formal psychiatric consultation is obtained.
Patient education is an essential part of the evaluation process.
The transplant cardiologists and coordinators provide a detailed presentation of the quality of life and survival that can be expected following transplantation. At this 2-3 hour meeting the complex nature of medical care prior to and following transplantation is outlined. Topics include immunosuppressive medications and biopsies, as well as the potential complications of infection, rejection, coronary vasculopathy, and malignancy. The education process continues throughout the patients course both before and after transplant. The data collected during the evaluation process is presented during the Patient Management Conference which meets weekly.