How do I prepare for my transplant evaluation?

What is the goal of the evaluation?

What will happen during the evaluation process?

How do I prepare for my transplant evaluation?
Your personal doctor will let you know when it is time to meet with a doctor from the transplant team. He or she will ask you to call us to start the process. When you call us, we will send you a referral packet. At that time, you will need to do the following:

• Read the entire referral packet. If you need help reading or understanding the information, you may call the Transplant Center.
• Complete the Transplant Application in the referral packet. Return it to us in the envelope provided.
• Contact your health insurance provider to ask about your coverage. Explain that you will be having a lung or heart-lung transplant evaluation at the University of Minnesota Medical Center. This is also a good time to discuss post-transplant costs for home care and medicines. (Your social worker will talk to you about this during your evaluation. A financial representative will also be available to talk with you if you have questions about your insurance coverage.)
• Complete the Release of Information form in your referral packet, and return it in the envelope provided. This will allow us to obtain your medical records. Once we receive your records, we will call you to discuss your evaluation. If you are very sick, you may have to stay in the hospital during your evaluation.

What is the goal of the evaluation?
The goal of your evaluation is to decide if a lung or heart-lung transplant is the best treatment for you. We will:

• Check for problems that might occur during or after your transplant.
• Review and adjust your diet and treatment so that you will be in the best possible health for your transplant.
• Teach you more about lung transplant surgery, after-care and what to expect while waiting for your transplant.
• Allow you to meet the transplant team.
• Discuss your transplant options.

What will happen during the evaluation process?
In most cases, an evaluation takes four to five days. It will consist of several doctor and clinic visits. You will also attend a two-hour pre-transplant class. Please bring the following with you to the evaluation visits:

• A family member or close friend. This person can help you take notes and ask questions.
• Your medicines and oxygen supply. If you use oxygen, you should have enough to get to and from the clinic each day. We can refill you oxygen tank at the clinic.
• Copies of your medical records and chest X-rays, if we do not already have them.
• The dates of your most recent shots for: pneumonia, hepatitis B, TB (Mantoux)
• Comfortable clothes and walking shoes.
• A book or magazine. You will have time to wait between your tests.

Drug, alcohol and nicotine assessment
If you have a history of drug or heavy alcohol use, you may need to have a formal chemical dependency evaluation. You must follow through with any recommendations from this evaluation, including further treatment if prescribed.

You must be nicotine-free for at least four months before starting your transplant evaluation. (This means no nicotine products, including nicotine gum, the nicotine patch or chewing tobacco.) We may test you for nicotine use at any time. You will be asked to sign a contract to show that you agree to remain nicotine-free. All recent smokers will need to take part in a quit-smoking program.

Doctor consultations
You will meet the transplant team doctors. Your transplant coordinator may be with you during some of these visits.

A pulmonologist (lung doctor) will review your records and complete an exam. If the doctor thinks you might need a transplant, you will see him or her regularly. He or she will help manage your disease.

The transplant surgeon will explain the operation, possible risks.

You may see other doctors as well, including a cardiologist (heart doctor), nephrologist (kidney doctor), endocrinologist (hormone doctor), neurologist (brain doctor) and psychiatrist. Feel free to ask questions at any time.

Blood, urine and skin patch tests
You will have many blood and urine tests, including:

• Standard tests to measure liver and kidney function, protein levels, electrolytes and clotting factors.
• Blood type tests
• PSA test for men over 50 (to check for prostate cancer).
• Pregnancy test for women of childbearing age.
• Tests for viruses such as hepatitis A, hepatitis B, hepatitis C and HIV.

You will also have a Mantoux test to see if you have been exposed to tuberculosis (an infection that affects the lungs.) Please let us know if you have ever had a positive Mantoux test.

Nutrition consult
A dietitian will check your height and weight, then review your lab work to check your nutrition levels. The dietitian may ask you about your eating and drinking habits. He or she will use the details to measure your routine calorie and protein totals. You may also receive advice about your diet. Please tell the dietitian if you would like to meet with him or her again.

Scans and X-rays
You may have:

• A chest CT scan. This is a special X-ray that makes cross-section pictures of your chest. We use these pictures to learn more about your disease.
• Chest X-rays. We will use the X-rays to measure your lungs. This tells us the size your donor will need to be.
• Spine and hip X-rays and bone density (DEXA) scan. If you have a transplant, you will need to take steroid medicines. Steroids can lead to osteoporosis (brittle bones). These tests will tell us if you have, or are at risk for, this problem. If you have bone disease, we may have you take medicine to strengthen your bones before your transplant. Please tell your coordinator if you have had a DEXA scan in the past.
• MUGA (gated blood pool scan). This scan shows the size and shape of your heart. It also tells us how well the heart is working. It can measure the amount of blood pumped from your heart with each heartbeat.
• Perfusion scan. This shows how much of each lung is working normally. It also shows how much blood is getting to each lung. The results may tell us which lung should be transplanted, if you are having a single-lung transplant.
• Other scans as needed. If you need further tests, we will explain them in detail.

Lung tests
Breathing tests (called pulmonary function tests) will tell us the extent and nature of your lung disease. A six-minute walk will tell us about your ability to exercise.

Heart tests
You will have:

• An electrocardiogram (EKG). This shows the patterns of the electrical waves in your heart. It will help us see how your heart is working.
• An echocardiogram (echo). This is an ultrasound of your heart. Sound waves create an image of the heart on a video screen. It tells us about the size and function of your heart.
• Coronary angiogram (heart catheterization). This test will measure the pressures in your heart. It will also look for any blockage in the vessels in your heart. You will learn more about this before the test.
  --You cannot have anything to eat or drink for six to eight hours before this test. We will try to schedule it early in the morning.
  --We will likely give you medicine to help you relax before the test.
  --After the test, you will lie flat with you leg straight for two to four hours.
  --You will need someone to drive you home.

Swallowing and GERD tests

• A swallowing test (called esophageal manometry) will show how well your esophagus works when you swallow. (Your esophagus connects your throat to your stomach.) To do this test, we will numb your nose and throat.
• After the swallowing test, we will leave an even smaller tube in place overnight. You do not have to stay overnight in the hospital. This test will check the acid level in your esophagus. If the acid level is high, you may have GERD (gastroesophageal reflux disease)). GERD can cause lung problems before and after transplant. If you have it, it is important for us to treat it.

Support services consult
A pulmonary (lung) rehab therapist will discuss how you can stay in the best possible shape while you wait for your transplant. If needed, he or she will direct you to a rehab program near your home.

You will meet with a social worker to discuss support services. He or she can help with changes that you and your family may need to make in the short-term.
 
Financial consult
A financial case manager will discuss the costs of both the transplant and the medicines needed afterward. He or she will help you understand your insurance—what it will cover and what it won’t.