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If, despite treatment optimisation and other changes, the heart failure is very advanced, a study is started to assess whether or not the patient needs a heart transplant, and if this is actually possible.
Complete analysis, involving blood group, renal and hepatic function, serology of old infections, cultures, and so on.
Immunological study to find out whether the patient will accept the new heart.
Echocardiogram to confirm heart dysfunction and whether there is any disease in the heart valves that would allow any other treatment.
Left heart catheterisation to rule out any diseases in the heart arteries that may be treated.
Right heart catheterisation to find out if the patient is suffering from pulmonary hypertension (high pressure in the pulmonary arteries).
Ultrasound and/or abdominal CT scan to rule out other injuries.
Peripheral and carotid vascular study to rule out lesions in the leg and carotid arteries.
Visit with a social worker and psychiatrist.
Once the study is complete, all the team members (cardiologists, surgeons, nurses, psychiatrists, anaesthesiologists, and social workers) evaluate the various treatment options. When the patient is considered to be a "good candidate", they are put on what is known as a waiting list.
The waiting list
The time a patient spends on the waiting list is very variable. It depends, particularly, on the patient's weight and their blood type. During this period, the patient is asked to live close to the hospital, at most 1.5 hours away.
As long as the patient remains stable, they periodically visit the hospital so their symptoms can be evaluated and their medication adjusted. If at any time they do not feel well, they can bring the visit forward and/or go to Accident and Emergency.
There are times when a patient deteriorates clinically and must be kept in the hospital for a few days. In some cases, if their symptoms do not improve, they are given priority on the waiting list.