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Hamzah Choudhry: Expert Management Averts Need For Lvad During Two-Week Transplant Wait
Hamzah Choudhry, a college student in Blue Springs, Missouri, awoke one morning struggling to breathe. A visit to the student health center began a harrowing journey marked by repeated cardiac arrest and culminating in an emergency flight to Cleveland Clinic.
There, Hamzah learned that he has Uhl anomaly, an extremely rare congenital disorder resulting in partial or total loss of myocardial muscle in the right ventricle. He urgently needed a heart transplant.
During the two weeks he waited for a donor heart, Hamzah was able to avoid the need for an LVAD thanks to expert management in Cleveland Clinic's heart failure ICU, one of the few of its kind in the nation. He was critically ill yet remained stable until he was successfully transplanted when a matched donor heart surfaced.
"Before the transplant I couldn't walk because I was always out of breath and got really tired," says Hamzah, who is now 21 and back at school. "Now I'm twice as active as before."
44 heart transplants in 2015, including:
While the first official heart transplant at Cleveland Clinic was performed in 1968, Cleveland Clinic's Cardiac Transplant Program team began regular heart transplantation services in 1984, with 2014 marking the 30th anniversary of these services.
Since the program began, staff surgeons have performed more than 1,600 heart transplants. Additionally, staff performed several dual organ transplants including heart/liver, heart/lung and heart/kidney transplants.
Read about the first official heart transplant at Cleveland Clinic.
The Scientific Registry of Transplant Recipients (SRTR) (Release date: June 17, 2014) demonstrates that for patients receiving their first transplant between January 1, 2011 and June 30, 2013, patient survival at 1 year is 90.30%; this is statistically comparable to the projected 91.53% predicted survival based on a risk adjusted estimate.
For the past 20 years, the U.S. News & World Report "Annual Best Hospitals Survey" has voted the nation's busiest heart center as also the nation's best. Cleveland Clinic's Heart Center tops the magazine's 2014-15 rankings of best heart and heart transplant surgery hospitals.
Cleveland Clinic's Heart Transplant Program is a member of the Ohio Solid Organ Transplant Consortium (OSOTC) and the United Network For Organ Sharing (UNOS).
The Centers for Medicare and Medicaid Services has certified Cleveland Clinic as a Medicare Center for heart transplantation.
If you or a loved one would like a second opinion from a top specialist at Cleveland Clinic, but may be disabled or find it too difficult to travel, we offer MyConsult. The MyConsult program is an online medical second opinion that connects you to our physician experts who will review your medical records and diagnostic tests to assess your suitability for transplant.
For more information about heart transplantation at Cleveland Clinic, please contact the Pre-Transplant office
Phone: 216.444.8351
Toll-free: 800.223.2273 ext. 48351
At Cleveland Clinic, we reflect upon heart transplantation as a complex process with ethical implications. This is because donor organs are scarce and heart transplantation management is a life-long concern requiring compliance to a doctor prescribed regimen that includes a healthy diet, exercise, and long-term medication after heart transplantation.
The first step in establishing a treatment partnership with the Cleveland Clinic Heart Transplant Team while undergoing an evaluation for your suitability as a heart transplantation candidate. We rely upon a series of tests and evaluations with specialists to ascertain your heart transplantation eligibility.
Not all patients are clinically appropriate for heart transplantation, as there may be findings that would predict failure of the transplanted organ. Furthermore, not all patients referred will need transplantation, other medication and alternatives may exist.
Your doctor has contacted the Cleveland Clinic's heart transplant team to have you evaluated for heart transplant or other therapies for heart failure.
A cardiologist will review your records and decide an appropriate testing for you. After recommendations are made you will be sent to our scheduling office to get your appointments set up. The evaluation by the heart failure cardiologist may take place in the hospital or in the outpatient clinic.
The purpose of the evaluation is to determine the severity of your heart disease, and which form of therapy is best suited to your condition, and whether a heart transplant is an option. We do not recommend cardiac transplantation unless it is absolutely necessary, and likely to be associated with long-term success. Often times, other treatments are possible, including other medical and surgical options.
The cardiologist will talk to you about your family history; medical history including previous evaluations, past hospitalizations, and treatments; surgical history; and social history. The doctor will perform a complete physical examination
Psychological issues often play an important role in the long-term success of your heart transplant surgery. Emotional stability and a supportive social environment are key factors. To increase our understanding of these elements in your life, the transplant social worker will conduct a detailed psychosocial evaluation prior to heart transplant surgery. Some general areas considered are:
Understanding your medical diagnosis and how your disease has progressed will help us determine your level of acceptance of cardiac transplant as a therapeutic option.
Your family history and cultural factors provide information regarding your living situation.
Finding out about your life and family relationships is essential to the transplant process. These relationships impact both the pre- and post-transplant period.
Your hobbies and activities you enjoy may be useful in helping you cope with the period of waiting for an organ and setting recovery goals after transplant.
Includes family, friends, the community, and church. Positive support from family members, loved ones, and friends is essential during the phases of transplant and helps to ensure a successful recovery.
Finding out about your education level can be useful in evaluating your ability to understand medical directions, as well as assist in job placement after transplant. Military history may reveal eligibility for back-up health care systems such as the Veteran's Administration Medical Center.
This helps the business office to establish financial eligibility. Are there benefits for which you are eligible, but have not applied or been granted?
Adherence to past medical advice and treatment plans can be a predictor of how well you will stick to future medical advice. History of smoking, alcohol, drug abuse, as well as compulsive overeating, raises concern about successful follow-up. Past and present psychiatric history is also explored.
The social worker will assess your strengths, coping resources, and areas of concern regarding your ability to tolerate the transplant process. The concerns may be great enough to reconsider recommendation for transplant.
The social worker's role is to use counseling skills and community resources to help you and your family maintain normal life activities during the transplant process. Information regarding housing needs also can be discussed with the social worker.
At this time, we recommend that you start making healthy lifestyle changes. These include: stopping tobacco use, eating healthy foods, stopping alcohol or use of illegal drugs, and following an exercise program. If you need help making lifestyle changes, your social worker can assist you with strategies or refer you to other resources such as a dietitian, smoking cessation specialist, or cardiac rehabilitation program. Making other major life changes, such as moving or changing jobs is not recommended at this time.
At times, grief and bereavement counseling is needed, as well as crisis intervention. Your social worker can help support your psychosocial needs and address them appropriately throughout the transplant process. The social worker has a responsibility to all transplant team members as well as to you and your family.
You may undergo a variety of tests to determine the extent of your heart disease and what has caused it. If these tests have been performed recently, they may not need to be repeated.
An Electrocardiogram records the electrical activity of the heart. It documents abnormal heart rhythms, previous heart attacks, and thickening of the heart muscle.
A Chest X-ray is a picture on film of the structures in the chest. It helps to determine the size of your heart, the status of the lungs and bony structures, and to determine whether fluid or congestion is present in the lungs.
A complete blood count, comprehensive metabolic profile, and protime INR are performed initially. If further testing is indicated, then blood typing and tissue typing will be performed. We will also check previous exposure to hepatitis, HIV, and other infectious agents.
High-frequency sound waves are used to provide pictures of the heart's valves and heart chambers. It helps us to determine the size and function of your heart.
A sheath (a hollow tube) is placed in a vein in the neck or in the groin. A thin flexible plastic tube is inserted through the sheath and advanced to the pulmonary artery. A computer is connected to the catheter and measures the amount of blood circulating through the body each minute. Pressures are recorded in the pulmonary artery and right heart chambers. The results help us to adjust medications for treating heart failure.
A sheath is placed in an artery in the groin. A small flexible plastic catheter (tube) is guided to the opening of the coronary arteries. Dye is injected to visualize the vessels and see whether blockages are present in the coronary arteries. A catheter is then placed in the left ventricle in order to measure the pump function of the heart.
This is a special treadmill test that gives a precise measurement of your functional capacity. During the test, a small mouthpiece is used to measure how much oxygen and carbon dioxide is breathed in and out. It provides us with objective evidence of your physical capabilities.
A machine measures the rate and amount of air inhaled and exhaled through a mouthpiece. This test helps to evaluate lung function. Poor lung function would exclude a patient from cardiac transplantation, and dictate alternative therapies.
A sound wave transducer wand is used to see whether there are blockages in the arteries that supply blood to the brain.
A sound wave transducer wand is used to identify gallstones, aortic aneurysm, or blockages in the abdominal blood vessels.
A Doppler probe (or wand) is used to identify blockages in the arteries supplying blood to your legs.
In certain patients, additional testing may be needed during the evaluation process: eye exam, CT scan, barium enema, upper GI series, or other consultations.
It is important to determine whether your teeth or gums may be a source of infection. You can be evaluated by a dentist at Cleveland Clinic or you can provide a clearance letter from your dentist stating that your teeth are in good condition and your mouth is free from infection.
Based on health history, family history and age, there may be health maintenance testing such as colonoscopy, pap smear, mammogram, vaccinations, ophthalmology and dermatology.
The transplant financial advisor is available to review insurance benefits with you and answer any questions. Unfortunately, a severe cardiac illness that requires transplant may involve a great deal of expense. We will make every effort to keep medical costs to a minimum.
The Social Security Administration is responsible for both the Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) programs. SSDI provides cash benefits for disabled workers (and their dependents) who have contributed to the Social Security trust fund through FICA tax on their earnings. SSI provides a minimum level income for the needy, aged, blind, and disabled.
Under both programs, the law defines disability as:
"the inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death, or has lasted or can be expected to last for a continuous period of not less than 12 months..."
"the inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death, or has lasted or can be expected to last for a continuous period of not less than 12 months..."
Although some patients are able to continue working while they await transplant, there are others who already have been receiving benefits due to disability caused by their cardiac problems. Others apply for these benefits after the need for transplant is established. Disability forms should be brought to Cleveland Clinic to be completed along with the most current information possible. We will accurately describe your current condition.
It is important to note that disability insurance may be temporary. After transplant, your benefits may be discontinued, as we expect you to return to your normal daily activities and work.
While you are waiting for transplant, you can take important steps to ensure return to work by considering your options and beginning to make arrangements for this before the surgery is performed (see returning to work).
A heart failure patient and family should be prepared to stay in the Cleveland area during the three to five day evaluation period. Additionally, patients will have to remain in the Cleveland area for four to six weeks after heart transplantation. There are hotels located on Cleveland Clinic campus. There are also hotels in the Cleveland area. With these, however, you will need to drive to and from Cleveland Clinic. Some hotel rooms may have kitchenettes.
Food costs vary depending upon living arrangements. As you make your hotel reservations, you may want to ask about room costs to be prepared for expenses.
There are housing specialists in the Department of Social Work who can discuss housing options with you. They can be reached at 216.444.5132.
There is a cost to park at Cleveland Clinic's visitor parking garage, however discounts are available if you need to park there for several days.
The transplant team meets every week to review new and current patients. The results of testing and evaluation are carefully reviewed by the AHFTC (Advanced Heart Failure Therapeutics Committee), and a decision is made about your suitability as a candidate for heart transplantation.
Acceptance into our program as a heart transplant candidate means the transplant team believes:
Each case is different and every effort is made to make this decision based on the risk/benefit ratio of your particular case. Any alternatives to transplantation will be considered. In certain cases, the risks of transplant will be greater than others. This is discussed in detail with each patient accepted to the program.
If the committee approves you as a candidate, you will be asked to make a final decision regarding placement on the heart transplant waiting list. If you agree to proceed, we will submit your data to OSOTC (Ohio Solid Organ Transplant Consortium). Once we receive approval from OSOTC, we will move forward with listing you on the United Network of Organ Sharing (UNOS) wait list.
If you are accepted as a transplant candidate, you are listed in the United Network of Organ Sharing (UNOS) computer. This is a nationwide computer list of all people in the country who are awaiting transplant. Once you are listed, you are re-evaluated every three months. If your condition improves or deteriorates, you may be removed from the list.
Each listed patient is assigned one of four status ratings based on clinical status. Your status may change as your condition changes.
It is impossible to tell exactly how long you will wait for your new heart. Some people wait only a few days while others wait for a month or a year or longer. Allocation of organs is based on rules established by UNOS and is related to many factors, including blood type, body size, status and waiting time.
This is the highest priority. Status 1A patients must require at least one of the following:
Cleveland Clinic not only performs single heart transplants, but has also performed dual organ transplantation for:
The Heart Transplant Team is a group of physicians, surgeons, nurses, dietitians, exercise physiologists, social workers, and other healthcare specialists who are experts in the field of heart transplantation.
Cleveland Clinic's Transplant Team is dedicated to a coordinated approach to the care of the transplant patient.
The process of heart transplantation takes a team effort from evaluation to recovery. Your heart transplant team consists of nurses, physicians, surgeons, dietitians, social workers, and cardiac rehabilitation specialists who work with each patient and their family to aid in the success of their heart transplant.
The more you and your family know about your heart transplant prior to heart transplant surgery, the better your long-term outcome after heart transplantation will be. Our goal is to relieve some of your anxiety about heart transplantation and help you enjoy the outcomes following your heart transplant.
The Heart Transplant Team is a group of physicians, surgeons, nurses, dietitians, exercise physiologists, social workers, and other health care team members who are experts in the field of heart transplantation. Cleveland Clinic's Heart Transplant Team is dedicated to a coordinated approach to the care of the heart transplant patient. This approach starts with the evaluation, continues through the heart transplant surgery, and follows through to recovery following transplant.
If you or your local cardiologist have questions or concerns related to heart transplantation, please contact your physician at Cleveland Clinic.
Following your heart transplant, any medical problems, questions, outpatient appointments, biopsy results, medication changes, etc. post-transplant will be handled by the heart transplant coordinators: Phone: 216445.6590 Toll-free: 800.223.2273 ext. 56590.
If heart transplant personnel are unavailable, please leave a message and your call will be returned as soon as possible. Messages are checked frequently during the day.
If a heart becomes available and you are not in the hospital, we will call you at home or on your cell phone. It is important that you are available at all times of the day or night. Please keep your cell phone nearby when you are not at home. We will ask you what number is best to reach you. You should be available 24 hours a day.
In some cases, the coordinator may arrange for transportation to Cleveland Clinic, or tell you to standby for further instructions. Be sure to notify the Transplant Coordinator if your phone number changes, or if you will be at another location. Always notify the transplant office of any other plans.
When you get the call from your Transplant Coordinator that a donor heart has been located, you will need to come to Cleveland Clinic as soon as possible.
When you are told to come to the hospital, remember:
Go directly to the intensive care unit for hospital admission. You will be met in the Cardiothoracic Intensive Care Unit (CTICU) by the nursing staff. If you are waiting for transplant in the hospital, the coordinator will notify you of transplant and you will be transferred to the CTICU.
You will be taken on your bed to the operating room. You can expect the operating room to be brightly lit, cool and somewhat noisy, with a lot of people getting ready for the surgery.
Up to three members of the transplant team will go to evaluate the donor heart. Once the staff member have seen and determined the donor heart is satisfactory, he/she will contact your transplant surgeon.
At this time your surgeon will receive details on when the donor heart will arrive. We will then proceed with your surgery. Your family will be notified that the donor heart has been accepted and that surgery is proceeding.
There is always a possibility that the donor heart is not functioning properly or the donor may become too unstable to continue with transplant. The surgeon will inform you of this event as soon as they are aware of the situation. Please do not be too disappointed if this happens. We always have your best interest uppermost in our minds. If you are an inpatient, you will be transferred back to your nursing floor. If you are an outpatient you will likely have your IV lines removed and be discharged to home.
The cardiothoracic anesthesia team will start to administer your general anesthesia through one of your IV lines. You will begin to feel sleepy and heavy. You will fall asleep quickly. Hearing will be the last sense to leave you before you go to sleep.
The cardiothoracic anesthesiology team will be using state-of-the-art equipment and safety features, including monitors that ensure you are safely anesthetized and asleep throughout your surgery. The team will constantly monitor your electrocardiogram, pulse rate, blood pressure, respiration and other vital body functions.
The surgeon will make an incision through your sternum (breast bone). You will be placed on a cardiopulmonary bypass machine that will mechanically take over the functions of the heart and lungs during the surgery.
The donor heart is removed by cutting the aorta and pulmonary artery in the mid sections. The atria are excised from the veins leading into the heart. When the donor heart arrives in the operating room, the surgeons will remove your heart and the donor heart will be placed in proper position.
There are two methods by which this occurs.
The donor and recipient's left atria are connected. Then the right atria are connected. Finally, the aorta, pulmonary artery and pulmonary veins are sutured together.
The donor and recipient's aorta, inferior and superior vena cava, pulmonary artery and pulmonary veins are sutured together.
The donor heart comes with its own electrical system, the sinus node, and its own coronary artery supply.
When the heart is removed from the body, the nervous system is disconnected. The heart continues to beat adequately, but without the external nerve supply. This is referred to as a denervated heart. Small temporary pacemaker wires are attached to your new heart during surgery, and brought out through the skin near the base of the incision in case a temporary pacemaker is needed after surgery to assist the heart rate. If they are not needed, they will be removed when staff feels it is appropriate, usually by post-op day five or patient depending.
The actual surgery may last from four to 12 hours, and sometimes longer. Each patient and each case is different. Please remember that if your surgery takes eight hours and another patient's surgery only took three hours, it does not mean that you are doing worse than the other patient.
While you are in the hospital, your cardiologist may treat your heart failure symptoms in a special critical care unit. Physicians and nurses in this unit are specially trained to provide aggressive medical care and education to you and your family. Your transplant team will follow your progress and help you recover as quickly as possible.
After your transplant, you will be taking medications called "immunosuppressants." These drugs prevent your body's immune system from rejecting your new heart. However, they also increase your risk for infection.
During your hospital stay, you should begin to take steps to avoid infection. Many of these good habits will also help you prevent infection at home.
If you have symptoms of infection, notify your health care provider right away. Look for these signs:
While you are in the hospital, your cardiologist may treat your heart failure symptoms in a special critical care unit. Physicians and nurses in this unit are specially trained to provide aggressive medical care and education to you and your family.
You may be asked to keep track of the fluids you drink (your "intake"), the amount you urinate (your "output") and your weight every day you are in the hospital.
You will also be provided with written handouts about weight control, medications and self care expectations. Try to review this information and if you have any questions, please ask. If your hospital stay is long, you will also take part in our "self-medication program."
Nutrition therapy is an essential component of your transplant medical care at Cleveland Clinic. We provide three meals a day with snacks, as requested or designed by your dietitian.
The meals you receive are calculated for the amount of fat, sodium, and fluid that are specific to your needs. The foods you eat work in conjunction with your medications and other medical therapies for an optimal health outcome.
Therefore, it is important that you do not receive foods from an outside source—including restaurants and vending machines throughout the hospital, food from home, as well as food from neighboring restaurants—because we are not able to specifically determine the fat, sodium or fluid content of these foods. In addition, we are not able to determine if other foods were prepared safely.
The Nutrition Therapy Department and your health care team appreciate your cooperation with this important guideline.
If you have any questions about this, please talk with your dietitian.
An intra-aortic balloon pump is a temporary mechanical assist device placed in patients with severe heart failure who do not respond to oral or intravenous (IV) medications.
The balloon pump helps to reduce the workload of the heart muscle. It consists of a large balloon catheter that is inserted into an artery in the groin. The catheter is connected to a computer console placed next to the bed. The computer coordinates inflation and deflation of the balloon.
While the heart is at rest (in between heart beats), the balloon inflates, enhancing blood flow to the arteries that supply the heart muscle. During the heart's contraction, it deflates, allowing the heart to squeeze out more blood with less work.
While the balloon pump is in place, it is very important to lie flat in bed. The nurse will assist the patient in turning from side to side to help increase comfort. While this device is in place, a pumping sound will be heard which can be scary to some patients. It is the sound of the machine, not the heart pumping. In most instances, the use of a balloon pump is limited to one week or less.
An implantable left ventricular assist device (LVAD), (called the HeartMate II) is a pump, weighing a few pounds. The pump is surgically implanted in patients with very severe heart failure. The inlet portion of the pump is connected to the tip of the heart.
The outlet portion of the pump is connected to the aorta inside the chest. As such, LVAD implantation is a major surgical procedure. Unlike the intra-aortic balloon pump, the LVAD allows for increased mobility over time.
After a recovery period, patients begin to gradually increase their activity, begin to care for and manage their device, and may eventually leave the hospital. These patients are listed as Status IA/B candidates.
Cleveland Clinic is committed to providing you with respectful care as we meet your health care needs during your heart transplant. For this reason, we want you to have a summary of your rights as a heart transplant patient.
This is a summary of your responsibilities as a patient at Cleveland Clinic.
We believe it is important for you to be an active participant in your healthcare. This is a summary of your responsibilities in the hospital as you await your heart transplant.
When you wake up, you will be in the Cardiothoracic Intensive Care Unit (CTICU). A team of specially trained physicians and nurses will monitor your care and help you recover safely and quickly.
The CTICU is a busy place. You can expect bright lights and many noises. These noises are the monitors and different types of equipment. Many of these machines continuously monitor your heart rate and rhythm and blood pressure to help your surgeon determine how well your heart is functioning. Try to tune the equipment noises out and relax.
You will become aware of the endotracheal tube (breathing tube) that was inserted while you were asleep. The tube is connected to a respirator that assists your breathing. While it is in place, you will not be able to talk or swallow.
The nurse will anticipate your needs and ask you questions that require only a yes or no answer. Nod or shake your head yes or no. The breathing tube will be removed when you are fully awake and able to breathe on your own. Once it is removed, you will be able to talk, however you may have a sore throat and a hoarse voice.
Deep breathing and coughing exercises, as well as changes in position, are extremely important to prevent postoperative pneumonia.
When the breathing tube is removed, the nurses and respiratory therapists will help you do deep breathing and coughing exercises to inflate your lungs and cough out any secretions that have settled in your lungs during surgery.
You should change your position frequently while in bed.
You will have drainage tubes, called "chest tubes", to drain fluid which accumulates around your heart and lungs during surgery. The drainage from these tubes will be bloody at first. The tubes are removed when the drainage is clear and decreases in amount.
Fluids and medications are administered through an IV line in your neck. Immunosuppressant drugs will be administered through this IV until you are able to take fluids and eat.
You may experience pain when you first wake up. You will be given medications to control pain. Our pain control program is designed to keep you as comfortable as possible. However, if the medications affect your breathing and/or blood pressure, your physician may decrease the amount of pain medication given to you.
If you would like to use other methods of pain control, such as soothing music or relaxation tapes, small tape players with headphones are allowed in the CTICU.
It is normal for your new heart to beat faster at rest. Also, your heart rate will not rise as quickly with increases in activity. This may cause you to feel light-headed if you get up too fast from a resting position. You will need to get up slowly from lying or sitting and will need to warm-up when exercising.
The length of stay in the CTICU varies with each patient. Your transplant team will determine the best time to be transferred to the Transplant Special Care Unit. This usually takes place within 2-3 days after transplant.
Because you are taking immunosuppressant medications, certain viruses or bacteria which are normally harmless can cause you to become sick. These are called "opportunistic infections." The types of infections include:
Tuberculosis (TB) is a mycobacterial infection that is contracted by breathing infected air-borne droplets. Potential transplant recipients may receive a skin test during the transplant evaluation to determine previous exposure to TB.
Symptoms of tuberculosis include:
Your immune system is made up of mostly white blood cells that fight infection. It can also work against your new heart, treating it as an unwanted, foreign object. To prevent this from occurring, you take immunosuppressant medications - to suppress or work against your natural immune system so that rejection does not occur.
However, the same medications that help prevent rejection also increase your risk for infection. For the first six months after surgery, the likelihood for rejection is highest, so you will be taking higher doses of these medications. This makes you even more vulnerable to infection. You must take caution to protect yourself from infection.
Recovery after your heart transplant is similar to the recovery after any heart surgery. It takes about six to eight weeks for your incisions to heal.
At first, you may have some muscle or incision discomfort in your chest during activity. Itching, tightness, or numbness along your incision are also normal. Follow the guidelines below to ensure proper healing:
Good nutrition is an important part of healing. You will need to eat a diet that is low in salt and fat, but also one that includes a variety of healthy foods to help you heal. If you are having trouble with your appetite or understanding your dietary guidelines, please ask your transplant team to speak to a dietitian.
If you have any of these signs of infection, call your doctor.
You will need to take medications the rest of your life to prevent your body from rejecting your new heart and to treat other medical problems. Always take your medications as directed. By the time you leave the hospital, you should be taking all of your medications without help from the nurses.
These medications are used in conjunction with a low-cholesterol diet to help reduce your lipid levels and to help reduce the risk of traditional and/or transplant coronary artery disease.
Keep minor cuts and wounds clean. Wash them with soap and water or hydrogen peroxide, dry your skin and cover the cut with a sterile bandage.
Go to the emergency room near your home if you have a deep cut, or one that bleeds a lot. Be sure to tell the health care providers that you are a transplant patient.
Call your doctor if your wounds become red and drain anything but clear liquid.
Frequently wash your hands with soap and warm water, especially before preparing food, and after using the bathroom or after touching soiled linens or clothes. Lather well, rubbing your hands back and forth together, to clean all surfaces, including the nail beds and webbing between your fingers.
Shower or bathe daily using a mild soap. Special soap is not needed at home. If you have dry skin, apply a mild skin lotion after bathing.
Prednisone and cyclosporine, two medications that you must take, can cause acne.
Keep your skin as clean and oil free as possible and use a washcloth and mild soap. You may want to avoid soaps that contain pumice or coconut oil. Some over-the-counter acne products may be helpful, but be sure to use non-comedogenic skin care products and cosmetics
Make an appointment with a dermatologist (skin doctor) if acne becomes a problem.
Overexposure to the sun can also cause skin irritation as well as cause dry skin, sunburn, blisters and can increase the risk of skin cancer. Some of your medications may make you more sensitive to the sun's rays.
Always wear a sunblock lotion, sun protective factor (SPF) of 15 or greater when outdoors in bright sunlight. Wear a broad-brimmed hat and protective clothing such as light pants instead of shorts, long-sleeved shirt, and socks to protect your feet and lower legs. When swimming, wear a T-shirt over your bathing suit.
Check your skin for new markings; especially new irregular shaped, raised, red, black or brown markings. If you notice any new skin markings, see a skin doctor (dermatologist) for prompt evaluation and treatment.
In some patients, cyclosporine (Neoral) can cause gums to swell, become tender, and sensitive to heat and cold. Poor diet can also cause gum disease. Sore, bleeding gums can easily become infected. Good dental care may help prevent infection.
Examine your mouth and gums every day. If you have red or swollen gums, contact your transplant coordinator. Be sure to brush your teeth and gums thoroughly after each meal with a small, soft toothbrush and fluoride toothpaste. Use foam sticks instead of a toothbrush if your gums are especially sore. Also use dental floss every day and keep dentures clean and fitting properly.
Your doctor may tell you to use an antibacterial mouthwash rinse. Avoid commercial mouthwashes or throat lozenges that contain a high concentration of alcohol - they may irritate or dry your mouth.
Prepare a gargle by dissolving one teaspoon each of salt and baking soda in a quart of warm water. (A smaller portion of this can be made by stirring 1/4 teaspoon each of salt and baking soda into eight ounces of warm water.) Rinse your mouth and gargle with this solution at least four to six times a day, especially after meals and before going to bed.
Have your teeth cleaned and checked by a dentist at least every six months. Tell your dentist that you have had a transplant before your appointment so he or she can take precautions to prevent possible infection. Also be sure to call your transplant coordinator for an antibiotic prescription at least one week before any of your dental appointments.
If a mouth sore develops, eat foods that are warm or at room temperature and avoid eating acidic foods and beverages (such as tomatoes and oranges).
Friends and family will want to visit you when you return home. It is important to teach them how they can help you best.
Limit your visitors for the first couple weeks and instruct visitors to avoid sending or bringing live plants. If your visitors have cold or flu symptoms, ask them to return when they are feeling well. Before visiting with an infant or child, check with the Transplant Team.
Get a flu shot every fall (by October 15). You cannot get the flu by getting the immunization. Encourage your adult family members to get flu shots also. You can arrange to get the flu shot from your doctor or Transplant Team.
Ask your doctor if you should get a pneumovax (pneumonia) vaccine. Ask your doctor how often you should get this shot, and whether your adult family members should also get the shot.
Do not receive any vaccines (other than tetanus or flu shot) without first talking to your doctor. Do not receive any live virus vaccines or be in contact with people who recently received one. A live virus vaccine may trigger an infection in someone who is taking immunosuppressant medications.
Make sure you receive the 3-shot Hepatitis B series.
Do not go into crowded places for the first three months after your transplant. If you cannot control how far away you can stay from other people, it is probably a crowd. Do not work in or visit any form of construction site.
Keep your house clean and free of excess dust. Dust can be harmful to you after your transplant. If you absolutely must go near this type of area, wear a mask provided by the Transplant Team. You may have pets, but have other family members or friends clean the litter box, cage or yard. In addition, do not add any new pets to your home, especially birds.
If you enjoy fishing, use caution with fish hooks, fish fins, and fillet knives. Protective gloves should be worn when handling these items. Also avoid gardening for the first six months after your transplant. Wear garden gloves when gardening. Soil has many molds and fungi that can be sources of infection. Do not mow the lawn yourself and avoid areas where people are mowing. A lawn mower blows bacteria from the grass which can cause an infection.
Stay away from hot tubs, whirlpools, saunas or steam baths. Germs tend to multiply in these.
Be sure to ask your Transplant Team when you can safely return to work or school.
Starting at Age
Preventive Care
How Often?
Starting at Age 30
Starting at Age 50
In some patients, cyclosporine (Neoral) can cause gums to swell, become tender, and sensitive to heat and cold. Poor diet can also cause gum disease. Sore, bleeding gums can easily become infected. Good dental care may help prevent infection.
Here are some general guidelines:
A dermatology assessment will be done pre-transplant and annually post-transplant.
Follow these guidelines for skin care:
Prednisone and cyclosporine, two medications that you must take, can cause acne. To lessen skin problems:
Overexposure to the sun can cause dry skin, sunburn, blisters and increase the risk of skin cancer. Some of your medications may make you more sensitive to the sun's rays.
To avoid overexposure:
Get a flu shot every fall. You cannot get the flu by getting the immunization. Encourage your adult family members to get flu shots also. You can arrange to get the flu shot from your doctor or Transplant Team.
Do not receive any vaccines (other than tetanus or flu shot) without first talking to your doctor. Do not receive any live virus vaccines or be in contact with people who recently received one. A live virus vaccine may trigger an infection in someone who is taking immunosuppressant medications.
Make sure you receive the 3-shot Hepatitis B series and two shots Hepatitis A series (if you tested negative).
During the months of illness before heart transplant surgery, you and your family made many adjustments. The purpose of having heart transplant surgery was to make you feel better and to live a full life again. Let's review some areas of life often affected by your transplant.
Caring for your personal hygiene
By the time you leave the hospital after your heart transplantation, you should take care of all your personal hygiene, (bathing, shaving, dressing). Continue to perform these activities at home.
Light chores
It takes about six weeks for your sternum (breastbone) to heal after heart transplantation. During this time, you may do light household chores such as laundry, shopping, cooking, and washing dishes. But, do not lift objects that weigh more than 10 pounds. These include suitcases, grocery bags, full laundry baskets, pets or children.
Also avoid activities that require pushing or pulling heavy objects, such as shoveling snow or mowing the lawn. Your doctor will tell you when you can resume these activities during your heart transplantation follow-ups.
Driving after your heart transplantation
You may not drive for at least six weeks. However, you may be a passenger as often as you like. For the first two weeks after your heart transplantation, you may want to stick close to home to avoid infections or becoming overtired. Over time, increase your outings and begin to get back to activities you enjoy after your heart transplantation. Your doctor will tell you when you can begin driving a car.
Pace yourself
Spread your activities throughout the day. Schedule the most important ones early. Reschedule unfinished activities for another time. You may climb stairs, but you may need to slow your pace or rest midway if you become tired.
Get a good night's sleep
Many people complain of trouble sleeping for a time after any heart transplantation surgery. This can be due to the affects of anesthesia, discomfort related to healing, changes in your daily routine, or concerns you may have. Without enough rest, you may feel overtired and irritable. If you cannot sleep, try these tips:
Begin a Lifelong Exercise Program After Your Heart Transplantation
Regular exercise is a vital part of your new lifestyle. The transplanted heart is only 70 percent as efficient as a normal heart. So, you must exercise regularly to maintain physical fitness.
Exercise will help you:
Exercise after your transplant
Your doctor or cardiac exercise specialist will give you a home program based on your needs, current abilities and the new response patterns of your heart. Follow these guidelines when you return home.
To be safe, follow these exercise tips:
Be alert for signs of exercising too hard. These include:
If these symptoms occur, stop the activity and rest. Call your doctor if these symptoms last longer than 20 minutes or if they occur on a regular basis.
In the hospital after your transplant, an exercise specialist provided basic guidelines on your exercise program. This is commonly referred to as Phase I Cardiac Rehabilitation. Upon discharge, it is important to continue with your exercise program.
A Phase II cardiac rehab program can help you learn about your transplant, lifestyle changes and assist you in maintaining your exercise program.
Phase II cardiac rehab is offered at Cleveland Clinic, or you can be referred to a program closer to your home.
For more information on Cardiac Rehabilitation, contact the Preventive Cardiology and Rehabilitation Program at 216.444.9353.
Before your heart transplant, you may have been on disability. With your new heart, your disability may be stopped. Most transplant patients are physically able to return to work. Studies have shown that people who return to work feel better about themselves and do better physically, as well.
Depending upon the type of work or your company's sick leave policy, you may or may not be able to return to your former job. However, we do not expect you to remain inactive.
If you are out of work, it is important to explore other job options for the future. You should look for ways to re-enter the job market. This may involve job retraining.
Vocational Rehabilitation Services (VRS) is available to provide you with many types of assistance to return to employment. This help can take the form of counseling, training, and job placement. VRS can provide training through technical schools, junior colleges, and colleges. A referral for these services can be made by your Social Worker.
Sometimes, after transplant, there are barriers to return to work. Some employers are hesitant to hire transplant patients. The "Americans With Disabilities Act" provides some protection from this discrimination.
This, together with education, can help employers begin to feel confident that transplant patients can be good, reliable employees. Patients who can maintain an employee status with their employers (whether active or on leave) during the wait for transplant seem to have an easier time returning to work after transplant.
Staying active is very important. If you are retired, volunteer for a local school, hospital, or charitable organization. This will allow you to remain physically and mentally active.
Finances may play a big part in your recovery and the outlook for the future. If you have concerns about your finances related to insurance, disability, medications or employment, please discuss this with your social worker. There are many resources available to help you.P lease call 216-445-7119 with any financial questions.
This may be a stressful time for your whole family. Roles may have changed during the pre-transplant period. Spouses, children, and other relatives may have taken over daily responsibilities. Now, it is time to re-establish your family roles and relationships.
Families feel better and cope better when they discuss each member's feelings about the transplant and plans for the future.
Young children may be overlooked in this process - whether they are your children or your grandchildren. It is important to discuss their feelings and fears as well. The transplant team social worker is available to help children and families adjust to illness and health.
After the excitement of the heart transplant, some people have feelings of a "let down." You or your family may notice mood changes or times of feeling "down" or "blue."
Other patients may become irritable. They may have quick bouts of anger or "fly off the handle" at little things. This may be related to high expectations after the transplant and attempting to live up to them. It may also be related to normal healing or medications (steroids). These are normal emotional responses that will diminish with time.
Remember, you need medications. Therefore, you must anticipate some side effects. As your doses are safely decreased, mood changes will lessen.
It may also help to share your feelings with your spouse, a friend, or clergyman. Open discussion of feelings will help you and your family understand how you feel. Support groups are available for patients who have had transplants.
If you still don't feel quite right after the early stages of recovering, and you feel your emotional changes are interfering with your ability to enjoy life, tell a member of the transplant team. Supportive counseling may be helpful.
Many patients and their partners feel nervous about resuming sexual activity after surgery. The amount of energy it requires to perform intercourse with a spouse or regular partner is similar to climbing about one or two flights of stairs or walking about one half mile (0.8 km) at a brisk pace.
If you cannot perform these activities without getting angina, or shortness of breath, or becoming overtired, please allow additional recovery time before resuming sexual activity. For the first six to eight weeks, you may need to use a low stress position to limit pressure or weight on the breast bone. Keep in mind that a sexual relationship has both physical and emotional aspects.
Anxiety for either partner as well as some medications may interfere with sexual arousal and performance. Discuss any concerns with your doctor.
Soon, you and your partner will return to a satisfying emotional and physical relationship.
As a heart transplant patient, you have agreed to avoid tobacco and illicit drugs and to limit alcohol. All of these substances can be harmful. There are several reasons for limiting alcohol:
Limit your daily alcohol intake to one 6-ounce glass of table wine, or one 12-ounce beer, or 1.5 ounces of distilled liquor (gin, rum, vodka, whiskey) per day.
If you need help in avoiding these substances, please contact your doctor, nurse, or social worker.
Heart Transplant surgery is a major operation and therefore may involve complications. Below is a list of possible complications after surgery. Our goal is to minimize your risk, but always educate you on what might occur.
Hypertension after transplant can be caused by many factors, such as your medications, changes in the function of your kidneys, or too much sodium (salt) in your diet.
At home, you will be asked to check and record your daily blood pressure, heart rate and weight.
We strongly encourage you to purchase an automatic blood pressure monitor which can provide an accurate assessment of your heart rate and guidelines:
Follow your doctor's guidelines about alcohol use. In general, you should limit your daily alcohol consumption to no more than two drinks per day for men and one drink per day for women and lower-weight individuals. One drink equals:
Take your blood pressure medications as prescribed.
Bring your blood pressure records to each visit and report high blood pressure readings in-between visits.
Transplant patients have an increased risk of developing malignant tumors and cancers. Because transplant patients need to take immunosuppressant medications, malignant cells may escape detection and destruction by the immune system and develop into a tumor.
Tumors that are common in the general population, such as breast cancer, lung cancer, and colon cancer, do not seem to occur more frequently in transplant patients. Skin cancers are the most common tumor in transplant patients. Sun exposure is the major risk factor for skin cancer.
Signs and symptoms may include:
If you have any of these signs or symptoms, please contact your doctor for prompt evaluation. Lymphomas are diagnosed by biopsy of a lymph node or nodule. Other tests may be performed to determine if other organs are involved.
Check your neck, armpits, and groin area for lumps or new growths. Report signs of these to your doctor.
Treatment consists of a change in the immunosuppressant medication dosage and/or schedule, and sometimes chemotherapy or radiation therapy.
The immune system is the body's defense against foreign invaders. Made up of mostly white blood cells, its job is to destroy germs such as bacteria and viruses, and help to fight other diseases.
Your white blood cells are made up of different teams of fighter cells, called B and T cells. B cells fight germs by producing antibodies. Antibodies are strong weapons against infections, causing germs to become harmless.
T cells kill foreign invaders, such as germs and cancer cells. Each time your body has an immune reaction, it memorizes the foreign body (antigen) and how it was stopped so that it can respond quickly the next time that same antigen is introduced.
The immune system is very helpful and powerful, but it cannot tell the difference between "bad invaders," such as germs, and "good invaders," such as a transplanted heart. As a normal response, your body's immune system sees the new heart as a foreign invader and attempts to destroy it. Immunosuppressant medications are given to stop this process.
If the immune system is able to attack the transplanted heart, it is called rejection. Rejection must be detected and treated quickly to prevent damage to the transplanted heart.
Rejection may seem frightening to some transplant patients, but deaths from rejection are uncommon. Most cases of rejection are detected by biopsy and tissue staining and occur without any symptoms.
Rejection can be hyperacute, acute or chronic.
Hyperacute reactions occur if you have been exposed to the same or similar antigens found in the donor heart. Previous exposure to these antigens may have occurred through blood transfusion, pregnancy or prior transplants. Hyperacute rejection occurs rarely, because transplant recipients undergo testing to determine if they have pre-formed antibodies which increase the risk for this problem. However, when it does occur, the body's immune system reacts swiftly and strongly, sometimes causing failure to the new organ within the first few hours after transplant.
The PRA (panel of reactive antibodies) test is performed by taking a sample of the recipient's blood and mixing it with samples of blood from multiple donors in the community. Blood from many volunteers is obtained because together they represent most of the human antigens to which a potential recipient may have been exposed.
A cross-match test is done when a local potential donor is found. The organ procurement agency will send a sample of the donor's blood to be combined with a stored sample of the recipient's blood. If the recipient's blood cells destroy donor cells, it means that pre-formed antibodies have reacted with donor antigens. The cross-match is termed "positive" and indicates that a heart transplant with this donor may be risky. Usually the procedure is canceled because of the high likelihood of hyperacute rejection.
Recipients with pre-formed antibodies (high PRA) may have a longer waiting time because of the need to match with an appropriate donor. It is important to note the PRA can change with time or exposure to blood, and occasional retesting may be necessary.
There are two forms of acute rejection: cellular and vascular.
Acute cellular rejection: This type of rejection occurs after the recipient's white blood cells realize that the transplanted organ is foreign and mount a defense against it. Immunosuppressants block the immune response. Without these medications, transplanted organs would probably fail within two to four weeks as a result of acute cellular rejection.
The chances of acute cellular rejection are greatest during the first six months after transplant. Most people have one or more episodes of acute rejection during that time. The chance of acute cellular rejection decreases with time and remains very low after the first year because of immunosuppressive medications and tolerance to the transplanted organ.
Source: International Society of Heart and Lung Transplantation: "Classification of Acute Rejection"
Note: Acute vascular rejection has a different grading system.
Acute vascular rejection: Acute vascular rejection is a type of acute rejection that occurs early after transplant (within the first four months) in a small number of patients. Vascular rejection causes damage to the innermost layer of the coronary arteries. This leads to scarring and a decrease in blood flow, potentially leading to other heart complications. It is also believed that patients with vascular rejection are more prone to developing post-transplant coronary artery disease.
Vascular rejection has been dramatically reduced with the change to triple therapy drug treatment. Findings of vascular rejection are now rare.
It is important to know the signs and symptoms of rejection. In most cases, rejection does not cause any signs or symptoms. In more advanced stages, you may feel:
Most patients do not have symptoms. If symptoms occur, please call your transplant coordinator or cardiologist right away.
The foods you eat can help you heal and resist infection after organ transplantation. Other foods may need to be avoided. Here are some general guidelines for nutrition following organ transplantation:
Keeping a healthy diet is one of your most important jobs after your organ transplantation. Your diet plays an important role in helping you heal, avoiding weight gain, and maintaining your health into the future.
The four key areas you need to focus on for your diet following organ transplantation include:
1. Follow a low-sodium (salt) diet.
Sodium causes your body to hold in (retain) fluids. A diet high in sodium can lead to high blood pressure. Prednisone, a medication often prescribed after heart transplant, causes you to retain sodium and fluids. So if you are taking this drug, controlling sodium in your diet is even more important. Your doctor will tell you how much sodium you should have in one day - usually 2000 mg is the upper limit. Sodium is found in table salt and many of the foods we eat, most commonly, preserved foods, canned foods, luncheon meats, cheeses and snacks.
Here are some tips to limit sodium in your diet following your organ transplantation:
2. Eat foods low in fat and cholesterol.
A high-fat diet will lead to high blood cholesterol, which is a major risk factor for coronary artery disease. This disease can reduce blood flow to the heart and damage your new heart. Because cyclosporine tends to raise blood cholesterol levels and prednisone tends to cause weight gain, you may have an increased risk of developing coronary artery disease after heart transplant. The best way to decrease this risk is to decrease the amount of fat in your diet.
Here are some tips for a low-fat and low-cholesterol diet:
3. Control your weight by balancing your meals with exercise.
Weight gain is very common after transplant, as one side effect of your medications is an increased appetite. If you are overweight, your heart must work harder to pump blood and it can lead to increased cholesterol, triglycerides, blood sugar, and blood pressure.
So, it is important to achieve and maintain an optimal weight. Here are some guidelines:
4. Include a variety of healthy foods in your diet.
A healthy, balanced diet will help you maintain your weight, control your blood pressure, cholesterol and blood sugar and help you feel better.
Include a variety of foods in your diet. Try to eat foods from each food group.
Eat foods high in fiber. Fresh fruits and vegetables, legumes (beans), and grains contain many vitamins, lower blood cholesterol and may also protect against cancer and heart disease.
To protect against high blood pressure, eat foods rich in potassium, calcium, and magnesium. Certain diuretics contribute to loss of potassium and magnesium, so if you are taking these drugs, this is even more important to include: fresh fruits (especially bananas and strawberries), dried fruits, skim milk, and fresh vegetables. Some medical conditions (such as kidney disease) and medications (potassium-sparing diuretics), may require you to LIMIT the amount of potassium in your diet.
Talk with your doctor about including potassium-rich foods in your diet.
It is up to you to recognize the symptoms of infection and get treatment as soon as any of these symptoms occur.
Note: Prednisone can mask the usual signs of infection so make sure you get treatment promptly. Don't wait!
Call your healthcare provider right away if you notice any of these symptoms:
After you leave the transplant center, our goal is to help you adjust and live a healthy life. At the transplant center, we will help you address the following issues:
Lifelong follow-up appointments with your doctor are very important after heart transplant. Some of your heart transplant medications can affect your body in different ways. Your doctor will monitor your body's responses after heart transplant and will adjust your medications as needed.
When you first leave the hospital after heart transplant, you will need to visit your cardiologist often (about once a week). You will need to stay in the Cleveland area with a family member or friend for the first month after your heart transplant. Later, your visits will be less frequent.
If you need to arrange housing after your heart transplant, discuss this with your social worker or housing specialist.
It is important to bring all your medications and your daily log to the doctor at each visit following your heart transplant. The following information should be recorded in your log:
This information helps your doctor adjust your medications and care to make your heart transplant recovery as effective as possible.
Your appointments with your cardiologist may include:
To detect the development of coronary artery disease (chronic rejection), your doctor will check your heart's arteries and overall function several weeks after your transplant. Two tests will be performed: a cardiac catheterization and intravascular ultrasound.
These tests will be repeated once a year.
You may need additional appointments with other specialists or doctors on the day of your appointment with your cardiologist. The post-transplant coordinator will schedule these visits. If you would like to make an appointment that has not been scheduled, please discuss this with your transplant doctor or transplant coordinator.
Notify your transplant coordinator if you have been prescribed any new medications by any other doctors.
Prevention and early detection is best. Some of the problems we may be looking for after transplant include hypertension, coronary artery disease, anemia, low white blood cell counts, skin cancers or other types of malignancy. It is important to see the following doctors for regular exams or as they are needed:
You should see an ophthalmologist for annual eye exams including glaucoma and cataract evaluations. Eye doctor appointments are important, since prednisone can cause vision changes.
Female patients should visit a gynecologist yearly for a pelvic examination and PAP smear, regardless of age. Mammograms should be performed regularly, as recommended by your doctor.
Male patients over age 50 years should have an annual PSA (prostate specific antigen) blood test.
Regular follow-up appointments with your dentist are important. Your gums may become swollen and bleed easily. Tell your dentist about your transplant so antibiotics can be prescribed for any dental procedure.
Wear sunscreen, protective clothing and a hat when outdoors because of an increased risk of skin cancer. If you notice any unusual skin growths, darkened spots or bumps, see a dermatologist as soon as possible. You may also want to consult a dermatologist if acne is a problem for you after transplant.
It is very important to control your risk factors for heart disease. If you have risk factors, such as high blood cholesterol, diabetes, hypertension, being overweight, smoking or high stress or anger, a preventive cardiology specialist can help you reach optimal control.
Sometimes you need to see your doctor before your next heart transplant follow-up. In between follow-up visits, call your heart transplant doctor or heart transplant nurse if you have:
Cleveland Clinic's pediatric transplant program began in 1965, with the first pediatric heart transplant performed on March 30, 1985.
In addition to clinical specialists, the entire pediatric team ensures the very best results for the child and adolescent patients, including the referring physician, the patient's family, specially trained cardiac nurses, allied health professionals, social workers and child life specialists.
For more information on Cleveland Clinic's pediatric transplant program, please call 216.444.6123.
Or visit Cleveland Clinic Children's Cardiology & CT Surgery Department.
You have the right to state your wishes regarding your medical treatment and heart transplant. A growing number of people are taking action before they become seriously ill. You may now state your healthcare preferences in writing, while you are still healthy and able to make such decisions prior to your heart transplant.
Cleveland Clinic is required by law to provide you, the patient, an explanation of your rights to make personal decisions regarding your own medical care. We also are required to ask you whether you have written down your wishes prior to your heart transplant.
You should know your options concerning the right to accept or refuse medical treatment and how you may make your wishes known about the care you want when you are unable to decide for yourself. You should know and understand your rights prior to your heart transplant.
These heart transplant and heart transplant surgery resources are provided for your information only. Inclusion does not imply endorsement by Cleveland Clinic. The heart transplant surgery information provided by these resources should not replace the advice of your healthcare providers.
American Heart Association
Phone: 800.AHA.USA.1
American Organ Transplant Association
Phone: 713.344.240
American Society of Transplantation
Phone: 856.439.9986
Email: email@example.com
Children's Organ Transplant Association
Phone: 800.366.2682
Division of Transplantation, U.S. Department of Health and Human Services
Phone: 301.443.7577
Financial assistance and information on establishing fundraising campaigns to pay for transplant.
Phone: 800.642.8399
Email: email@example.com
International Society for Heart and Lung Transplantation
Phone: 972.490.9495
Email: email@example.com
The federally designated, nonprofit organ procurement organization (OPO) for Northeast Ohio.
Phone: 888.558.LIFE (5433)
Email: email@example.com
National Foundation for Transplants
Phone: 800.489.3863
Email: firstname.lastname@example.com
The Organ Procurement and Transplantation Network
Phone: 888.TX.INFO.1
Nonprofit educational web site serving the world transplant community. Sponsored by Novartis.
Phone: 734.998.7314
Email: email@example.com
TRIO - Transplant Recipient International Organization
For all types of transplants.
Phone: 800.TRIO.386
Email: email@example.com
UNOS - United Network for Organ Sharing
Transplant Living
Patient Education website sponsored by UNOS
Phone: 888.894.6361
American Association of Tissue Banks
Phone: 703.827.9582
Email: firstname.lastname@example.com
Donate Life - Coalition On Donation
Phone: 804.782.4920
Email: email@example.com
Donate Life
Official U.S. government website for organ and tissue donation and transplantation
Gift of Life Foundation
Phone: 813.855.7600
Email: firstname.lastname@example.com
The Gift of a Lifetime
Stories about people whose lives are transformed by organ and tissue donation
Ohio Donor Registry
Phone: 888.745.1511
Email: email@example.com
Transplant Awareness Inc.
Sells merchandise to promote organ and tissue donation
Heart transplantation can be a daunting thing to face, so it helps to be familiar with the terminology. Compiled below is a glossary of terms you may find helpful to know as you go through the heart transplantation process.
Advance Directive: A document in which a person either states choices for medical treatment or designates someone who should make treatment choices if the person should become unable to make decisions. Most often the term refers to formal, written documents, but it can also be used to include spoken statements by the patient.
Allograft (allogeneic graft or homograft): An organ or tissue transplanted from one individual to another of the same species, i.e. human to human.
Antibody: A protein substance made by the body's immune system in response to a foreign substance, for example a previous transplant, blood transfusion or pregnancy. Because the antibodies attack the transplanted organ, heart transplantation patients must take powerful immunosuppressive drugs.
Antigen: A foreign molecule or substance, such as a transplant, that triggers an immune response. This response may be the production of antibodies.
Anti-hypertensive drug: A drug that reduces hypertension (high blood pressure).
Atherosclerosis: A disease in which fatty deposits accumulate on the inner walls of the arteries, causing narrowing or blockage that may result in a heart attack. Commonly known as "hardening of the arteries."
Attending or Primary Physician: The doctor who has the main responsibility for your care while you are in the hospital during heart transplantation. There may be other doctors caring for you such as consulting doctors, resident doctors, and medical students.
Bioethicist: Professionals who are skilled in helping people make decisions about what is morally right and wrong.
Biopsy: The removal of a sample of tissue via a small needle. The tissue is removed for examination to determine a diagnosis.
Blood Typing: A test that can help establish compatibility between two different types of blood. Blood types include A, B, AB or O.
Blood Urea Nitrogen (BUN): A waste product regularly removed by the kidneys and eliminated in the urine. Regular testing of the BUN level serves as an indicator of how well the kidney is functioning.
Brain Death: Brain damage that is so severe and extensive that the brain cannot recover. Breathing has stopped, but the circulation may still be continuing because of artificial ventilation. Donor organs can only be taken from people who are declared brain dead.
Breathing Tube (endotracheal tube): A temporary tube put into the nose or mouth. Anesthesia or air and oxygen pass through the tube allowing artificial breathing.
Cadaveric Donor: An individual who has recently passed away of causes not affecting the organ intended for transplantation. Cadaver organs usually come from people who have willed their organs before death by signing organ donor cards. Permission for donation also can be given by the deceased person's family at the time of death.
Catheter: A thin, flexible instrument used to introduce or withdraw fluids from the body. A catheter also may be used to monitor blood pressure.
Chest X-ray: Used to view the lungs and lower respiratory tract. A chest X-ray may be used for diagnosis and therapy.
Cholesterol: A fatty substance that is acquired in part from certain foods. A high cholesterol level may lead to atherosclerosis.
CPR (cardiopulmonary resuscitation): A procedure using cardiac and respiratory equipment and medications possibly to restore the heartbeat and/or breathing.
Compliance: The act of following orders and adhering to rules and policies, i.e. taking one's medications after transplant.
Complication: The occurrence of diseases or medical problems simultaneously in the body.
Coronary Angiography (Cardiac Catheterization): A procedure that allows picture to be taken of the arteries supplying the heart with blood (the coronary arteries). Angiography shows blockages in the arteries.
Creatinine: A waste product in the blood, creatinine is removed by the kidneys and eliminated in the urine. Regular testing of the creatinine level serves as an indicator of how well the kidney is functioning.
Crossmatch: A test that establishes the compatibility or closeness of blood between the organ donor and recipient. A positive crossmatch shows that the donor and patient are incompatible. A negative crossmatch means there is no reaction between donor and patient and that the transplant may proceed.
Cyclosporine Level Test: A blood test that measures the amount of cyclosporine in the blood. Based on the amount of cyclosporine measured, a physician decides what dose of cyclosporine is appropriate for a patient.
Cytomegalovirus (CMV): A common virus that may be present without symptoms in healthy people, but can be a serious condition if present in transplant patients.
Decisional Incapacity: A condition in which a patient is unable to understand his or her choices or declare personal wishes about his or her care.
Dialysis: An artificial means of cleansing the blood of waste products and removing fluids from the body when the patient's own kidneys are unable to continue this process.
Diastolic: The lower number in a blood pressure reading that indicates the pressure in the heart when the muscle is relaxed (the point of least pressure).
Diuretic: A drug that helps the body get rid of excess water by increasing the amount of urine the body excretes.
DNR Order (Do Not Resuscitate Order): An advanced directive that means no CPR is to be done when the heart and lungs stop.
Donor: A person who gives an organ, tissue or blood to another person. A compatible donor is a person who has the same tissue and blood types as the person who receives the organ, tissue or blood.
Durable Power of Attorney for Health Care: A written advance directive in which individuals name someone else (the "agent" or "proxy") to make health care decisions for them when they are unable to speak for themselves.
Echocardiogram: An imaging procedure that creates a moving picture outline of the heart's valves and chambers using high-frequency sound waves that come from a hand held wand placed on your chest or passed down your throat. Echo is often combined with Doppler ultrasound and color Doppler to evaluate blood flow across the heart's valves. Doppler senses the speed of sound and can pick up abnormal leakage or blockage of valves.
Electrocardiogram (EKG or ECG): A test that records on graph paper the electrical activity of the heart via small electrode patches attached to the skin. An EKG helps a physician determine the causes of abnormal heartbeat or detect heart damage.
Gingival Hypertrophy: Enlargement of the gums. A common side effect of the medication cyclosporine (Sandimmune), this condition is easily managed with good oral hygiene.
Glucose: Blood sugar. Manufactured by the body from carbohydrates, protein, and fat, glucose is the main source of energy for all living organisms.
Graft: A transplanted tissue or organ (such as the lung or liver).
Herpes: An infection for which transplant patients are at risk. It appears as small sores on the skin, lips or genitals. When there are no sores, the herpes virus lies dormant (not causing infection) in the body.
Hirsutism: An excessive increase of hair growth, sometimes leading to male-pattern hair growth in a female. A common side effect of corticosteroids, it can also occur with cyclosporine (Sandimmune) therapy. Hirsutism can be easily treated with depilatory creams or other hair removal methods.
Hypertension: High blood pressure.
HLA System (Human Leukocyte Antigens): There are three major genetically controlled groups: HLA-A, HLA-B and HLA-DR. In transplantation, the HLA tissue types of the donor and recipient are sometimes an important part of the selection process. This depends on the recipient's antibodies.
Histocompatibility Antigens: Molecules found on all nucleated cells in the body that characterize each individual as unique. These antigens are inherited from one's parents. Human leukocyte antigens determine the compatibility of tissues for transplantation from one individual to another.
Hospice: A program that provides care for the terminally ill in the form of pain relief, counseling, and support, either at home or in a facility.
Hydration: Provision of fluids by any means to prevent dehydration.
Immune Response: The body's defense against foreign objects or organisms, such as bacteria, viruses or transplanted organs or tissue.
Immune System: The body's response mechanism for fighting against bacteria, viruses and other foreign substances. If a cell or tissue (such as bacteria or a transplanted organ) is recognized as not belonging to the body, the immune system will act against the "invader." The immune system is the body's way to fight disease.
Immunosuppressant Drug: A drug that prevents the immune system from responding to cells that it recognizes as foreign to the body. Such drugs prevent the immune system from recognizing that a transplanted organ, such as a lung, is not the organ a person had when he or she was born.
Immunosuppression: The artificial suppression of the immune response, usually through drugs, so that the body will not reject a transplanted organ or tissue. Drugs commonly used to suppress the immune system after transplant include prednisone, azathioprine (Imuran), mycophenolate mofetil (CellCept), and cyclosporine (Neoral).
Infectious Disease Team: A team of physicians who help control the hospital environment to protect you against harmful sources of infection.
Intensive Care Unit (ICU): A special nursing area devoted to providing continuous and immediate care to seriously ill patients.
Intravenous (IV): Delivery of drugs, fluids or food directly into a vein.
Informed Consent: A process of reaching an agreement based on full disclosure. Informed consent has components of disclosure, comprehension, competence and voluntary response. Informed consent often refers to the process by which one decides to donate the organs of a loved one.
Legal Guardian: A person charged (usually by court appointment) with the power and duty of taking care of and managing the property and rights of another person who is unable to take care of their own affairs.
Life-Sustaining Treatment: A medical treatment given to a patient that prolongs life and delays death.
Living Will: A written advance directive in which an individual states which health care decisions should be made if the individual becomes unable to make these decisions.
Medical Student: A student in the third or fourth year of medical school training. The student doctor assists the primary and resident doctors in daily care of patients.
Noncompliance: Failure to follow instructions given by health care providers, such as not taking medication as prescribed or not attending follow-up appointments.
NOTA: The National Organ Transplant Act, passed by Congress in 1984, outlawed the sale of human organs and initiated the development of a national system for organ sharing and a scientific registry to collect and report transplant data.
Ohio Solid Organ Transplantation Consortium (OSOTC): An organization that establishes and enforces regulations to ensure equality in organ transplantation and fairness in distribution of donor organs.
Ombudsman: The staff of the Ombudsman's office is available to patients and family members to help investigate and solve problems with medical service. The Ombudsman acts as a "go-between" for the patient and Cleveland Clinic. The ombudsmen report directly to key administrators and have the authority to investigate patient complaints. To contact an ombudsman, call 216.444.2544.
Organ Preservation: Between procurement from a donor and heart transplantation, organs require special methods of preservation. The length of time that organs and tissues can be kept outside the body vary, depending on the organ, the preservation fluid and the temperature.
Palliative Care: Medical treatments intended to control suffering and discomfort (such as pain medication or treatment of an infection). These treatments will not cure the patient.
Panel Reactive Antibody (PRA): The percentage of cells from a panel of donors with which a potential recipient's blood serum reacts. The more antibodies in the recipient's blood, the higher the PRA. The higher the PRA, the less chance of getting a good crossmatch.
Patient Service Representative: Members of this department can address or direct questions concerning hospital policies and procedures, secure patient valuables and belongings, and provide notary service.
Permanently Unconscious State: A condition of coma in which a patient is irreversibly unaware of himself and his environment, and has a total loss of higher brain functioning, resulting in no capacity to experience pain or suffering.
Persistent Vegetative State: Same as "permanently unconscious state."
Pharmacologist: A medication specialist who checks your blood levels to monitor your response to immunosuppressive medications.
Physical Therapist: An expert who can recommend exercises to help you maintain flexibility and regain your strength.
Pre-transplant Evaluation: A series of interviews and tests for patients who are being considered for a transplant. It is the second step in the transplant evaluation process. After this evaluation, the transplant team decides if a transplant is a suitable treatment.
Pre-transplant Screening: A series of interviews and physical examinations for patients who are being considered for a transplant. Pre-transplant screening is the first step in the transplant process to discover if a patient has any condition that would immediately rule him or her out for a transplant.
Proxy: A person appointed to make decisions for someone else, as in a Durable Power of Attorney for Health Care (also called a surrogate or agent).
Pulmonary Function Test: A test used to reveal lung capacity and function, and to determine the blood's capacity to transport oxygen.
Pulmonologist: A staff physician with extensive training in lung disease.
Pulmonary Function Tests (PFTs): Tests that measure the volume of air that is inhaled and exhaled. The PFTs also measure gases, such as oxygen and carbon dioxide, in the lungs.
Recipient: A patient who receives an organ, tissue or blood from another person.
Rejection: The process by which the body tries to get rid of a transplanted organ or tissue by producing antibodies. Immunosuppressive drugs help to prevent rejection.
Required Request: Hospitals must tell the families of suitable donors that their loved one's organs and tissues can be used for transplant. This law is expected to increase the number of donated organs and tissues used for transplantation.
Resident Physician: A doctor who works closely with the primary physician to manage a patient's daily care. The resident is a licensed medical school graduate doing further training in one of the specialties of medicine.
Retransplantation: Due to organ rejection or transplant failure, some patients return to the waiting list. Reducing the number of retransplants is a critical concern when examining ways to maximize a limited supply of organs.
Sensitization: Potential recipients are "sensitized" if there are antibodies in their blood, usually because of pregnancy, blood transfusions or previous rejection of an organ transplant. Sensitization is measured by PRA. Highly sensitized patients are more likely to reject an organ transplant than unsensitized patients.
Side Effect: An unintended effect of a drug on tissues or organs other than the drug benefits.
Status: Indicated degree of medical urgency for patients awaiting transplants.
Survival Rates: Survival rates indicate the percentage of patients or grafts (transplanted organs) that are still alive and functioning at a certain point post-transplant. Survival rates are often given at one-, three-, and five-year increments. Policy modifications are never made without examining their impact on transplant survival rates. Survival rates improve with technological and scientific advancements. Developing policies that reflect and respond to these advances in transplantation will also improve survival rates.
Systolic: The top number in a blood pressure reading that indicates the force of the heart muscle's contractions as blood is pumped through the heart's chambers.
Terminal Condition: An irreversible, incurable, and untreatable condition from which there can be no recovery, and death is likely to occur soon. Nursing and medical efforts are administered to provide comfort.
Thrush: A yeast infection for which transplant patients are at risk. It can occur in the mouth or vagina.
Tissue Typing: A test that evaluates the compatibility or closeness of tissue between the organ donor and recipient.
TPN (total parenteral nutrition): A special intravenous (IV) solution providing hydration, vitamins, minerals and calories to sustain life. This IV is usually inserted into a large vein in the neck area.
Transplant Coordinator: A registered nurse who coordinates all of the events leading up to and following your transplant. The transplant coordinator helps arrange your pre-transplant tests and helps find a suitable donor.
Transplant Surgeon: The staff physician who performs the transplant surgery. The transplant surgeon follows your progress while you are in the hospital and monitors your post-transplant care after you are discharged.
Tube Feeding (enteral feeding): A temporary artificial method of providing food through a tube inserted into the stomach. This food is in a liquid form and contains calories, vitamins and electrolytes. Enteral feeding may be necessary when food cannot be taken by mouth.
UNOS: United Network for Organ Sharing - the national nonprofit agency that establishes and enforces regulations to ensure equality in organ transplantation and fairness in distribution of donor organs.
U.S. Scientific Registry of Transplant Recipients: A database of post-transplant information. Follow-up data on every transplant are used to track transplant center performance, transplant success rates and medical issues impacting transplant recipients. UNOS facilitates the collection, tracking and reporting of transplant recipient and donor data.
Ventilator: A machine used to assist or control breathing (may be called a respirator).
Waiting List: After evaluation by the transplant physician, and after committee presentation, a patient is added to the national waiting list by the transplant center. Lists are specific to both geographic area and organ type: heart, lung, kidney, pancreas, intestine, heart-lung, kidney-pancreas.
Each time a donor organ becomes available, the computer generates a list of potential recipients based on factors that include blood type, organ size, medical urgency and time on the waiting list.
A "new" United Network for Organ Sharing (UNOS) waiting list is generated each time an organ becomes available. There are many factors that go into the actual decision of donor selection and recipient matching. Although your place on the list and the amount of time you have been waiting for transplant are important factors, the transplant surgeon ultimately is the one to make the final decision.
To find a transplant specialist for your needs, contact the Transplant Center at 216.444.2394 (or toll-free 800.223.2273, ext. 42394)
Cleveland Clinic © 1995-2016. All Rights Reserved. 9500 Euclid Avenue, Cleveland, Ohio 44195 | 800.223.2273 | TTY 216.444.0261


text:
Quilting Color Trend: Blue
Blue is the trendy color in fabric! And with so many hues and prints, you can add it to your quilt for a classic look, choose a variety for a modern look, or play with fun prints for a touch of whimsy.
Rhapsody in Blue
Can you keep a secret? This Single Irish Chain quilt showcases a simple Nine-Patch in disguise.
Crossing Point
Cross and Crown blocks take center stage on a scrappy blue-and-white throw.
Roaring Waves
A range of blues and grays, gradating from light to dark, produce the look of waves on a stormy night. Pairing blue with gray instead of white puts a twist on the classic two-color combination.
Stars from the Past
Classic LeMoyne Star blocks in reproduction fabrics shine against a blue background.
Ships Ahoy!
You'll make waves with a nautical-theme crib quilt.
Red, White, and 'Bluetiful'
For a summery wall hanging, pair scrappy blues and crisp whites, then add small pops of red.
Out of the Blue
A range of blues from light to medium to dark forms a grid look in this wall hanging. Dark floral squares emerge from assorted lighter blues to give the project depth.
Sunny Skies
Cheery blue and yellow star in this sunny wall quilt.
Winter Blues
Make classic Churn Dash blocks in an icy color palette for a stunning winter table topper.
Cold Snap
Chain piecing makes easy work of the sharp points in this classic blue-and-white icy-crystal delight.
Way Around
A classic two-color combination offers timeless appeal.
Walk in the Woods
Use blue, green, and brown prints to create dreamy star blocks. The natural colors give the impression that the stars are sparkling down through a forest canopy.
Marbled Elegance
Skinny chains of light, medium, and dark blue squares run through a marbled, creamy field, mimicking the blue veins in the background print.
Bolts of Blue
Mix your favorite blue prints in a scrappy wall hanging that will have you doing anything but singing the blues. Choosing prints with splashes of white keeps the strips in the tone-on-tone sashing from getting lost.
Vive la French Country
On this inviting tablecloth, charming blue and yellow prints march around a border that looks like French tiles.
Classic Blue Heirloom Quilt
Pairing gray with blue instead of white with blue puts a twist on the classic two-color combination.
Modern-Day Cowboy Throw
Southwest colors like blues and reds bring the flavor of the Old West to a throw with a modern design.
Little Blue Triangle-Squares
Make a table topper that's perfect for pairing with fine china. Sixty-four tiny triangle-squares make up the quilt center.
Jewel Box
Jewel-tone blues, golds, and browns in subtle tone-on-tones create a rich wall hanging. Fussy-cutting striped fabric makes the Aster blocks pop.
Batik Strips Table Runner
Frame a panel of batik strips with bright piping for the center of a quick and easy table runner.
Round the Stars
Some color combos never go out of style. Create a two-color quilt that stands the test of time with classic blue and white prints.
Patchwork Pillow Pair
Piece squares and rectangles into classic Pineapple and Log Cabin blocks to easily create a stunning sun-and-sky color duo.
Blue-and-White Pinwheels
Add depth to a two-color quilt by using a variety of prints. Multiple blue and white prints in medium and light hues provide a subtle scrappiness.
Icy Blues
Combine shades of blue, white, and gray to create a wintertime wall hanging that lasts well past the holiday season.
Blue Ocean Waves
Serene aquas and cool blues rule in this tranquil wall hanging. Soft prints and large floral fabrics result in Ocean Waves blocks with less defined edges, adding to the relaxed feel of the piece.
Simple Stars Baby Quilt
For a quick-to-make baby quilt, set off eight star blocks with blue print sashing strips.
Checkerboard Squares
Square-in-a-square blocks set on point are surrounded by a striking blue toile to create a timeless, treasured quilt.
Floral and Paisley Chain Quilt
Join blues and creams to form a quilt top with a chain design.
Create one-way movement by arranging Four-Patch units and setting squares in a diagonal Irish Chain pattern.
Batik Triangle Stars
Different blue background prints make the four star blocks pop. Careful fabric placement creates the illusion that they're different.
Blossoms and Borders Wall Hanging
Triangle-squares join in multiple borders to frame the appliquéd blossoms.
1930s Doll Quilt
Triangle-squares rotate this way and that to create the overall diamond pattern. A variety of feed sack prints are held together visually by the use of a single solid blue fabric.
On the Fly
Foundation-pieced dragonflies in 8-inch blocks flit this way and that across this vibrant quilt.

subset: commoncrawl


text:
i think the air gear op theme "chain" by back-on
i think the air gear op theme "chain" by back-on
Why don't more people read these mangas?
i said air gear's opin theme earlier but i also like the op theme for ouran host club also "kiss kiss ur my love" sad isnt it
Why don't more people read these mangas?
from the one´s i´ve heard, i´ll say D.Gray-man
I think it must be "honey" from CCS and "loop" from TRC . I dunno why there're many people who actually heard these before but they're great. Both lines and the music.
Bow down= One Piece. All their songs are freaking awesome.
2nd in line= Hitman Reborn One word, "Splay."
3rd down the line= Darker than Black I know there's only one set of OP and ED but it's freaking good.
4th Best= Gintama "Pray" (Tommy Heavenly) started it all.
"The leopard is a cruel lover. His tenderness breaks the gazelle's heart."


text:
Inside North Korea
Associated Press photographer David Guttenfelder is in North Korea and has been documenting scenes around the country that offer a glimpse into a largely unseen side of North Korea, capturing images of daily life that are at times quirky, at other times haunting.
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We will promote constructive and witty comments to the top, so everyone sees them!


text:
Submit News
Apple Forced to Pay Samsung's Legal Fees in UK Court Order
Tiffany Kaiser
November 12, 2012 6:39 PM
Recipient E-mail
Sender E-mail
(Source: wpuploads.appadvice.com)
The UK court made this call after Apple posted an inaccurate notice on its UK website
After posting a snarky notice on its UK website, Apple was ordered to pay a majority of Samsung's legal fees.
Last month, a UK court ruling ordered Apple to
post a notice
to Samsung on its website, saying that the South Korean electronics maker didn't steal the designs of the iPad after all. Apple obeyed the order, but with a snarky tone that made sure to highlight a few facts in Apple's favor.
The UK court found that this notice was "false and misleading," and ordered Apple to take it down at once. Apple was
told to rewrite the apology
to Samsung, and it posted a notice on its website saying that its former "apology" was inaccurate. The new apology even
appeared in UK newspapers
However, a rewrite was not enough. The Court of Appeal of England and Wales has further ordered Apple to pay the legal fees of Samsung on an indemnity basis. The exact amount that Apple must pay is unclear, but reports are saying Apple will pay a majority of the fees.
The Apple-Samsung patent war began in April 2011 when Apple claimed Samsung was an
"iPhone, iPad copycat."
Apple worked pretty hard to ban Samsung's smartphones and tablets around the world, and successfully accomplished this in countries like Germany and Australia. Samsung launched a few lawsuits of its own regarding
3G patents
, and was also able to lift the ban on its Galaxy Tab 10.1 in Australia in December 2011. However, Samsung
wasn't so lucky in Germany
, where the Galaxy Tab 10.1 is still banned.
Back in August, a jury in the U.S. District Court for the Northern District of California reached an unfavorable verdict for Samsung, saying that the South Korean electronics maker was
guilty of violating technology patents
. In other words, most of Samsung's smartphones and tablets in question were found guilt of copying Apple's iPhone and iPad designs. It was ordered to pay $1.05 billion in damages to Apple.
Samsung suffered further losses in the U.S. when an ITC judge ruled that
Samsung violated four Apple patents
, including the flat front face with wider borders at the top and bottom, the lozenge-shaped speaker about the display screen; the translucent images for applications displayed on the screen, and the device's ability to detect when a headset is plugged in.
The Verge
"I f***ing cannot play Halo 2 multiplayer. I cannot do it." -- Bungie Technical Lead Chris Butcher
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