Patients referred for consideration of heart transplantation undergo a comprehensive evaluation designed to determine whether transplantation is indicated and to identify any conditions that might preclude safely offering this therapy. For many patients, intensification of heart failure treatment may provide enough benefit to delay the need for heart transplantation. For others, evaluation for transplantation proceeds with several tests including a cardiopulmonary stress test, echocardiography and cardiac catheterization. Consultation with a social worker and psychiatrist is also offered in advance to identify the special concerns our patients may experience with this therapy.

Once evaluated, patients are presented to the Recipient Review Committee. If consensus is reached, patients are then placed on a waiting list managed by the United Network for Organ Sharing (UNOS). The amount of time one spends waiting for a donor offer is variable. The main determinants of this time are the patient’s blood type, body size and degree of illness.

In order to successfully bridge the time from listing to transplantation, patients may be treated with intravenous medications to support the heart’s function. When this is inadequate, placement of a mechanical circulatory support device may be necessary. Mount Sinai Heart offers a broad spectrum of support devices including newer generation investigational devices such as the Jarvik 2000 axial flow pump.

In an attempt to extend transplantation to a wider population, Mount Sinai Heart offers an alternate listing program. This program recognizes that many patients who were previously denied transplant may be suitable candidates in this new era. An example of whom are patients who are of advanced age, but are otherwise healthy. Our approach is to match these patients with an expanded donor pool to achieve survival rates that match or exceed that of our overall program.