Heart Transplant: Evaluation, Recovery and Major Milestone
Dr. Shelly Hall discusses the evaluation, recovery, and major milestones of heart transplants.
Featured Speaker:
Shelley Hall, MD, FACC, FHFSA, FAST
Dr. Shelley Hall is the Chief of Transplant Cardiology, Mechanical Circulatory Support and Heart Failure at Baylor University Medical Center in Dallas and a Clinical Associate Professor at Texas A&M Health Science Center College of Medicine. Board-certified in Advanced Heart Failure and Transplant Cardiology, she studied medicine at the University of Texas Southwestern Medical School in Dallas. She finished her residency in internal medicine and also a fellowship in cardiology at UT Southwestern, with sub-specialty training in transplant cardiology and congestive heart failure. Transcription:
Heart Transplant: Evaluation, Recovery and Major Milestone
Caitlin Whyte: Welcome back to Heart Speak, the podcast from Baylor Scott and White Heart and Vascular Hospital. I'm your host, Caitlin Whyte. Today, we are talking with Dr. Shelley Hall, the Chief of Transplant, Cardiology, Mechanical Circulatory Support, and Heart Failure at Baylor University Medical Center in Dallas and a Clinical Associate Professor at Texas A&M Health Science Center, College of Medicine. We will be discussing with her heart transplants, from evaluation to recovery and other major milestones. Dr. Hall, approximately 3,500 Americans received a heart transplant in 2019. Now for a patient that was told they may need a heart transplant. What evaluation must be done to be added to the transplant wait list?
Dr. Hall: Yeah, it's actually a very complicated process. And in a nutshell, you have to have a heart condition, sick enough to qualify for transplant, but the rest of your body has to be well enough to go through the surgery and survive a long time afterwards. So you have a lot of tests. You see a lot of consultants. I always say that you learn more about your body than you ever wanted to learn all of your health maintenance tests. If you haven't been keeping that up to date, everything, head to toe, to check on your physical and psychological wellbeing, to try and get a successful outcome.
Host: Once your transplant cardiologist determines you are a candidate for a heart transplant, what is the waiting list process then?
Dr. Hall: Yeah. So you'll meet one of the transplant Cardiologists, you go through an evaluation. You're presented to our selection meeting where all of the key people that are part of the transplant program, sit and discuss the patients. And then if you are approved, I always say it's somewhat anticlimactic because you go to sleep that night, wake up the next day and things haven't changed. Getting wait-listed just that it's a waiting list and it's not like you can confirm a surgical date for a transplant. You can't order that heart and say, I'm going to have it next Tuesday. And so what happens is you're on the waitlist and you see your transplant cardiologist or the transplant team on a regular basis to make sure that things are stable and going well and no complications arise. And to make sure that you are still okay to be on the wait list. And then depending upon a lot of factors that can be weeks to months to years.
Host: Now, once we're on the list, how are the donors matched with those waiting?
Dr. Hall: Yeah. So the, UNO, which is the United Network for Organ Sharing manages the national donor organ, the waitlist and the rules for heart changed in 2018. And this was to help comply with a final rule, which was equity and trying get organs to the sickest patients across the country. The old system gave a bump up. If an organ was available in Dallas, Dallas recipients kind of got a first dibs, at least the sick ones did, but now what happens is it's a more geographical sharing. And so it's spread out much more to the sickest patients because those are the patients who are most likely to die on the wait list before they get an organ. So what's happened is that you absolutely have to be sicker now to get your organs, but you actually it's imperative that you're evaluated early before you get to that point, because of all of the extensive testing and consultations that you need to go through to get through the evaluation process and get listed. Can't do that when you're super ill. So we want our patients to be evaluated early, and then we follow that. We know them really well and says they get sicker. They're in better shape for that moment when they will get the organ.
Host: Now looking at life after the list, are there options for support during a patient's recovery? What advice do you have for those taking care of a new heart?
Dr. Hall: Yeah. So lots of things after transplant, the first is that we encourage you to live relatively close to the transplant hospital. We say about 50 miles. And so many people who are come from far away will stay in our campus housing that we have called twice blessed house, which is our apartment complex for transplant patients. We usually encourage this for the first six to eight weeks because a lot's happening to your body. You're recovering from surgery, you can't drive. And your body's adapting to a lot of new medicines that can sort of mess with your memory or how you're feeling. And so we always have to have somebody with you during that time. And that is an additional workload on the family. Cause you're not only you as the patient have to be here, but somebody in your family, as well to keep an eye on you and help support you.
So obviously having an involved family group of family or friends, not everybody has that one person that can be with them the whole time. And sometimes it takes a village. We do have a patient support group that we encourage everybody to participate in talking to others that have been through the same experience as you is very, very helpful. Obviously this has been going on virtually lately. It was in person before COVID. You will have to go through cardiac rehab, that is now open right now in the COVID world. They will help you with all of the aspects of the healthy lifestyle changes. Adapting from being a heart failure patient with a heart condition to now being able to work this heart can be very challenging for some people, they can be attentive about exercise and adapting to differences in diet now that you don't have to restrict your salt and water like you did when you were a heart failure patient.
So cardiac rehab is very, very important in the recovery process. And our rehab program is very, very familiar with heart transplant patients. Another unique thing for the patient is actually getting to see their old heart. And I, that sounds a little bit bizarre, but you know, their heart is removed and it's analyzed by a world-leading cardiac pathologist. And he started this program many years ago and a patient and whoever they want to bring with them can make an appointment and come and sit down and hold their heart and look at their heart. And he'll teach him and show them about the heart attack damage or things that they can do to take better care of this heart. And it's a really unique experience that all of them have been really grateful to have done that chose to do it
Host: And wrapping up here for a patient researching heart transplant centers. What should they be looking for in a program?
Dr. Hall: Well, number one is experience. You want to make sure that you're looking at a program that has a good amount of volume because experience comes with volume. And obviously it's been around for a while, it will demonstrate their experience as well. I've been at Baylor Dallas for over 23 years. I started in 1997 there, and in my time there we've done over 800 transplants. This month we were lucky enough to reach our 1000 heart transplant. We've done the most transplants in Texas and one of the top 10 programs in the nation. And that allows a lot of things. One, you know, your doctors and your care team are experienced. They have seen all kinds of things that can happen and are prepared to deal with those issues. In addition, it allows a lot of research. When you have a lot of volume, you can do clinical trials. And that means that patients have the ability to get to things that they might not otherwise been able to get to. Especially when some of the more traditional options for taking care of their condition, aren't working research clinical trials can be key to improve survival and improve quality of life.
Host: Wonderful. Dr. Hall, is there anything else you want to add to our conversation here about heart transplant?
Dr. Hall: Yeah. I think the important thing is to have it on the mind, if you've got advanced heart condition and have been in the hospital several times, or you're, you're deteriorating on your medications, you're not able to tolerate the heart failure medicines anymore. You can't do the basic activities of living then talk to your physician. A lot of times, it just doesn't come to the forefront. Your doctor's busy there. They're trying to deal with your issues at hand and it just doesn't pop into their head about, Oh, what about heart transplant? So the key is to about it. And if you've got an advanced heart condition, ask your doctor to reach out and see if heart transplant is an option for you.
Host: Well, thank you so much Dr. Hall for being with us today. To find an advanced heart failure Cardiologist on the medical staff of Baylor Scott and White heart and Vascular Hospital, Dallas and Baylor University Medical Center, call 1-844-BSW-DOCS. That's 1-844-BSW D O C S. To learn more about the advanced heart failure program, visit Baylorhearthospital.com or download the Baylor Heart Center App on your Apple device. I'm Caitlin Whyte, and this has been Heart Speak, stay well. Baylor Scott and White Heart and Vascular Hospital Fort Worth is a department of Baylor Scott and White Heart and Vascular Hospital, Dallas joint ownership with physicians.
Heart Transplant: Evaluation, Recovery and Major Milestone
Caitlin Whyte: Welcome back to Heart Speak, the podcast from Baylor Scott and White Heart and Vascular Hospital. I'm your host, Caitlin Whyte. Today, we are talking with Dr. Shelley Hall, the Chief of Transplant, Cardiology, Mechanical Circulatory Support, and Heart Failure at Baylor University Medical Center in Dallas and a Clinical Associate Professor at Texas A&M Health Science Center, College of Medicine. We will be discussing with her heart transplants, from evaluation to recovery and other major milestones. Dr. Hall, approximately 3,500 Americans received a heart transplant in 2019. Now for a patient that was told they may need a heart transplant. What evaluation must be done to be added to the transplant wait list?
Dr. Hall: Yeah, it's actually a very complicated process. And in a nutshell, you have to have a heart condition, sick enough to qualify for transplant, but the rest of your body has to be well enough to go through the surgery and survive a long time afterwards. So you have a lot of tests. You see a lot of consultants. I always say that you learn more about your body than you ever wanted to learn all of your health maintenance tests. If you haven't been keeping that up to date, everything, head to toe, to check on your physical and psychological wellbeing, to try and get a successful outcome.
Host: Once your transplant cardiologist determines you are a candidate for a heart transplant, what is the waiting list process then?
Dr. Hall: Yeah. So you'll meet one of the transplant Cardiologists, you go through an evaluation. You're presented to our selection meeting where all of the key people that are part of the transplant program, sit and discuss the patients. And then if you are approved, I always say it's somewhat anticlimactic because you go to sleep that night, wake up the next day and things haven't changed. Getting wait-listed just that it's a waiting list and it's not like you can confirm a surgical date for a transplant. You can't order that heart and say, I'm going to have it next Tuesday. And so what happens is you're on the waitlist and you see your transplant cardiologist or the transplant team on a regular basis to make sure that things are stable and going well and no complications arise. And to make sure that you are still okay to be on the wait list. And then depending upon a lot of factors that can be weeks to months to years.
Host: Now, once we're on the list, how are the donors matched with those waiting?
Dr. Hall: Yeah. So the, UNO, which is the United Network for Organ Sharing manages the national donor organ, the waitlist and the rules for heart changed in 2018. And this was to help comply with a final rule, which was equity and trying get organs to the sickest patients across the country. The old system gave a bump up. If an organ was available in Dallas, Dallas recipients kind of got a first dibs, at least the sick ones did, but now what happens is it's a more geographical sharing. And so it's spread out much more to the sickest patients because those are the patients who are most likely to die on the wait list before they get an organ. So what's happened is that you absolutely have to be sicker now to get your organs, but you actually it's imperative that you're evaluated early before you get to that point, because of all of the extensive testing and consultations that you need to go through to get through the evaluation process and get listed. Can't do that when you're super ill. So we want our patients to be evaluated early, and then we follow that. We know them really well and says they get sicker. They're in better shape for that moment when they will get the organ.
Host: Now looking at life after the list, are there options for support during a patient's recovery? What advice do you have for those taking care of a new heart?
Dr. Hall: Yeah. So lots of things after transplant, the first is that we encourage you to live relatively close to the transplant hospital. We say about 50 miles. And so many people who are come from far away will stay in our campus housing that we have called twice blessed house, which is our apartment complex for transplant patients. We usually encourage this for the first six to eight weeks because a lot's happening to your body. You're recovering from surgery, you can't drive. And your body's adapting to a lot of new medicines that can sort of mess with your memory or how you're feeling. And so we always have to have somebody with you during that time. And that is an additional workload on the family. Cause you're not only you as the patient have to be here, but somebody in your family, as well to keep an eye on you and help support you.
So obviously having an involved family group of family or friends, not everybody has that one person that can be with them the whole time. And sometimes it takes a village. We do have a patient support group that we encourage everybody to participate in talking to others that have been through the same experience as you is very, very helpful. Obviously this has been going on virtually lately. It was in person before COVID. You will have to go through cardiac rehab, that is now open right now in the COVID world. They will help you with all of the aspects of the healthy lifestyle changes. Adapting from being a heart failure patient with a heart condition to now being able to work this heart can be very challenging for some people, they can be attentive about exercise and adapting to differences in diet now that you don't have to restrict your salt and water like you did when you were a heart failure patient.
So cardiac rehab is very, very important in the recovery process. And our rehab program is very, very familiar with heart transplant patients. Another unique thing for the patient is actually getting to see their old heart. And I, that sounds a little bit bizarre, but you know, their heart is removed and it's analyzed by a world-leading cardiac pathologist. And he started this program many years ago and a patient and whoever they want to bring with them can make an appointment and come and sit down and hold their heart and look at their heart. And he'll teach him and show them about the heart attack damage or things that they can do to take better care of this heart. And it's a really unique experience that all of them have been really grateful to have done that chose to do it
Host: And wrapping up here for a patient researching heart transplant centers. What should they be looking for in a program?
Dr. Hall: Well, number one is experience. You want to make sure that you're looking at a program that has a good amount of volume because experience comes with volume. And obviously it's been around for a while, it will demonstrate their experience as well. I've been at Baylor Dallas for over 23 years. I started in 1997 there, and in my time there we've done over 800 transplants. This month we were lucky enough to reach our 1000 heart transplant. We've done the most transplants in Texas and one of the top 10 programs in the nation. And that allows a lot of things. One, you know, your doctors and your care team are experienced. They have seen all kinds of things that can happen and are prepared to deal with those issues. In addition, it allows a lot of research. When you have a lot of volume, you can do clinical trials. And that means that patients have the ability to get to things that they might not otherwise been able to get to. Especially when some of the more traditional options for taking care of their condition, aren't working research clinical trials can be key to improve survival and improve quality of life.
Host: Wonderful. Dr. Hall, is there anything else you want to add to our conversation here about heart transplant?
Dr. Hall: Yeah. I think the important thing is to have it on the mind, if you've got advanced heart condition and have been in the hospital several times, or you're, you're deteriorating on your medications, you're not able to tolerate the heart failure medicines anymore. You can't do the basic activities of living then talk to your physician. A lot of times, it just doesn't come to the forefront. Your doctor's busy there. They're trying to deal with your issues at hand and it just doesn't pop into their head about, Oh, what about heart transplant? So the key is to about it. And if you've got an advanced heart condition, ask your doctor to reach out and see if heart transplant is an option for you.
Host: Well, thank you so much Dr. Hall for being with us today. To find an advanced heart failure Cardiologist on the medical staff of Baylor Scott and White heart and Vascular Hospital, Dallas and Baylor University Medical Center, call 1-844-BSW-DOCS. That's 1-844-BSW D O C S. To learn more about the advanced heart failure program, visit Baylorhearthospital.com or download the Baylor Heart Center App on your Apple device. I'm Caitlin Whyte, and this has been Heart Speak, stay well. Baylor Scott and White Heart and Vascular Hospital Fort Worth is a department of Baylor Scott and White Heart and Vascular Hospital, Dallas joint ownership with physicians.