Life before transplantation

In order to become a candidate for heart transplantation, you must be:

• Relatively healthy despite the heart disease.

• No older than 65 years old.

• Preparedtocooperatewiththehealthservicesandtostrictlyfollowthetreatmentregimen.

• Obtain the consent and support of family members and loved ones.

You cannot qualify for a transplant, if you have:

1. Acute bacterial infection

2. HIV infection and viral hepatitis B + viral hepatitis C with signs of liver fibrosis

3. Symptomatic peripheral vascular disease, or cerebrovascular disease

4. Diabetes mellitus with target organ lesion (nephropathy, proliferative retinopathy, neuropathy)

5. Related neoplasm or tumor in the recent past (except basal cell and squamous cell skin cancer)

6. Severe lung disease

7. Impaired renal function

8. Recent pulmonary embolism

9. Pulmonary hypertension

10. Psychosocial factors. If you have mental health problems that may affect the ability to purposefully follow the complex treatment regimens after the transplant, including a history of non adherence to drug therapy or alcohol abuse, in adequate social support.

11. Smoking

12. Obesity: BMI> 30 or weight> 140% of an ideal body weight

13. Age: normallyolderthan65 year sold

The actions of experts during the evaluation.

All stages of the evaluation must take place under the supervision of the specialists of a transplant center.

• Your consulting cardiologist will give you the results of survey sand medical indications for the heart transplantation. With this, you can discuss the benefits of heart transplantation in relation to other methods of treatment, as well as all the possible complications after the heart transplantation. You will be followed up by this doctor before and after the transplantation.

• A cardiac surgeon. Before the operation a cardiac surgeon will explain the most common and serious risks during the heart transplant surgery.

• A psychologist or therapist will check your mental/ psychological state and ability to take care of yourself in the postoperative period. The doctor will discuss with you the possible psychosocial risks, such as depression, anxiety, and the ways to handle them.

• A nutritionist will examine your current diet and nutrition. He will tell you about special diets for patients with heart failure. He will help create a diet for a life-time period after heart transplantation.

If you have any questions, please ask specialists to make sure that you understand all the risks and benefits of the operation.

Analysis

1. You take blood tests in order to:

Identify your blood group, Rh factor.

Rate the performance of your heart, kidneys, liver, thyroid and immune system.

Get screened for the presence of other diseases (for example, hepatitis).

2. Ultra sound examination of the blood vessels.

We will conduct ultrasound of the blood vessels in the areas of neck, legs, chest and abdomen.

3. Echocardiogram.

This is an ultrasound examination of your heart. This is done in order to investigate the compartments of your heart.

4. Angiogram.

This study allows us to check for blood clots in the blood vessels of your heart.

5. Catheterization of the heart.

We will hold a study on the measurement of the pressure in the heart and in the blood vessels of the lungs.

If pulmonary pressure is too high, your doctor will prescribe you a treatment to reduce the pressure (high pulmonary pressure may cause failure of a new heart).

6. Screening for cancer.

Colonoscopy. This is the examination of the colon.

Testing stool samples for blood. Blood in the stool maybe a sign of cancer.

Men need to take a blood test and undergo an examination to check the function of the prostate gland.

Women need to undergo cervical screening and mammogram (x-ray of the breast).

7. Skin tests.

You will have the Mantoux test. If you have ever had a positive Mantoux test, you will need to tell your doctor.

8. Care for teeth and oral cavity.

It is important to take care of your teeth and gums. Infections in the mouth can lead to serious infections of the heart. You must complete all the necessary dental procedures before transplantation. You also need to further follow all recommendations of your dentist. Just tell the dentist that you have had a heart transplant surgery. After the transplant, you will need to take antibiotics before each visit to the dentist.

9. Influenza.

While waiting for a transplant get annually vaccinated against the flu. Family members who live with you, should also receive influenza vaccine.

10.Pneumonia.

You should get vaccinated for pneumonia if you have not been vaccinated during the past seven years.

You must keep track of all these vaccinations.

11. Take a load test to help find out what physical activity limitations you have due to the heart disease.

12. Support Group.

You can attend a variety of support groups. This is an opportunity to communicate with patients and their families to explore other patients after heart transplantation. In these groups, you can share experiences, help each other, discuss common problems and so on.

After the assessment procedure, the transplant team will talk about the results of the evaluation and discuss with you and your family all the concerns. If you are an ideal candidate for a heart transplant, you will be asked to read and sign an informed consent form in order to be placed on the waiting list for a donor heart transplant at JSC “National Research Center for Cardiac Surgery Center”. Upon signature, with the date and time of signing, you will be placed on a waiting list for a donor heart transplant.

If you do not meet the requirements, or voluntarily give up heart transplantation, the doctor will discuss with you other treatment options, such as:

• Medications, diet and other treatments that do not involve surgery.

• Other cardiac surgery (for example, bypass or valve replacement).

• Implantation of a pacemaker or defibrillator.

• Implantation of circulatory support device (VAD).

If you want to stop the assessment procedure, you can inform about it at anytime.