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Monday, August 30, 2010

Transplant part 1 (evaluation, screening & tests)

(I got this information for all 5 of these blogs from the Cleveland Clinic's website regarding their transplant program.)

Reported survival rates include percent one month after transplant, 85.8 percent one year after transplant and 64 percent three years after transplant.

Pre-Transplant Evaluation
The pre-transplant evaluation is first performed to make sure a lung transplant is the right treatment for you.

What is a pre-transplant evaluation?
•A pre-transplant evaluation includes a complete physical, meetings with members of the Lung Transplant Team and a series of tests.
•The evaluation may take several visits.
•The pre-transplant evaluation is performed to make sure you are physically able to undergo a transplant.
•The evaluation helps the transplant team identify and treat any potential problems before the transplant, as well as avoid potential complications after the transplant.
Insurance Information
It is the responsibility of you and your referring physician to have insurance approval in place for your screening appointment. Please notify your insurance company of your pre-transplant screening appointment with Cleveland Clinic Transplant Center. Make sure your insurance company will provide coverage for the pre-transplant screening. (Many insurance companies will only provide coverage at specified centers.)

More information about insurance coverage will be provided on the day of your pre-transplant evaluation appointment.

Social Worker
You may see a social worker during your evaluation appointment. Social workers can provide personal support to you and your family throughout the transplantation process. Social workers also offer:

•Counseling regarding lifestyle changes.
•Referrals to community and national agencies and support groups that offer both information and support to transplant patients.
•Information about home care services.
Financial Counselor
You will meet with a financial counselor who can review your insurance coverage for pre- and post-transplant expenses. The financial counselor also can provide information about social security disability, supplemental security income, Medicaid and Medicare.

Lab testing will be completed during your pre-transplant evaluation appointment. This testing will include a nicotine/cotinine blood level. This test indicates whether you are smoking, chewing tobacco or nicotine gum, using inhaled nicotine products, or are exposed to second-hand smoke.

The International Guidelines for Lung Transplant Candidacy require a patient to be nicotine free for six months before undergoing an evaluation for transplantation.

Pre-Transplant Screening
The pre-transplant screening is first performed to make sure a lung transplant is the right treatment for you.

Before your pre-transplant screening
Before your pre-transplant screening, a transplant coordinator will contact you and your physician to gather important information about your medical condition. This information includes:

•Brief medical history, including medications
•Pulmonary function studies
•Computed axial tomography (CAT) scan and/or chest X-ray, if performed in the
last year
•Insurance information
Once this information is received, a transplant coordinator will contact you for a telephone interview to further discuss your past medical history and lung disease.

During the pre-transplant screening
During the pre-transplant screening, you will have several X-rays, laboratory tests and breathing tests (called spirometry tests) to make sure you are eligible for a lung transplant.

The spirometry tests provide information about the extent of your lung disease and how well your lungs function. The tests are not painful, but may be uncomfortable.

You also will meet with a transplant pulmonologist (a staff physician with extensive training and experience in lung disease and transplantation). The pulmonologist will ask you questions about your condition.

The screening generally lasts most of the day. If the results of the screening evaluation indicate you are eligible for a lung transplant, you will be scheduled for a pre-transplant evaluation.

The day of your screening appointment
Your screening appointment day will begin with a series of breathing tests, discussion of your medical history and a physical examination. You also will meet with members of the Lung Transplant Team, including the pulmonologist, transplant coordinator, financial coordinator and social worker.

You may have to answer similar questions with each team member. Please be patient; although the questions are similar, each specialist is concerned with a specific aspect of your health and will gain a different perspective of your lung disease.

Required Tests
Why do I need to have pre-transplant evaluation tests?
Your pre-transplant evaluation includes a variety of medical tests that provide complete information about your overall health. The medical tests help the Lung Transplant Team identify any potential problems before the transplant surgery and avoid potential complications after the surgery.

Although each patient does not have the same tests, most of the tests included in this handout are common for all lung transplant patients. The tests required before the transplant are usually done on an outpatient basis and can be performed at your referring physician’s office or at Cleveland Clinic. Your transplant coordinator will help arrange these tests for you. Please ask your transplant coordinator any questions you have about the tests you will need.

If special instructions are required before any of these tests, you will receive a written form that explains what to do before the tests.

•Blood Tests
•Chest X-ray and CT SCAN
•Lung Tests
•Heart Tests
•Additional Tests For Women
•Other Tests
During your pre-transplant evaluation appointment, the Lung Transplant Team will decide if you will need any additional tests after your appointment. Additional tests can be performed at Cleveland Clinic or in your home community. Your transplant coordinator will help you make these arrangements

What happens after my pre-transplant evaluation?
At the end of your pre-transplant evaluation and after the test results are complete, the Lung Transplant Team will meet to jointly discuss whether or not a lung transplant is the appropriate treatment for you. The transplant coordinator will then notify you of the Team’s decision.

Please understand that abnormal test results may require further investigation. The goal of pre-transplant testing is to ensure that you will be able to undergo the transplant surgery and recover without any significant risk of complications.

If you are approved and are going to be placed on the organ waiting list, the transplant coordinator will tell you what you need to do while you wait for your transplant.

Financial Questions to Ask
If you have been approved for a lung transplant and are going to be placed on the organ waiting list, you will need to prepare yourself financially and clarify your insurance coverage while you wait for your transplant.

The transplant financial counselor and the transplant coordinator are always available to answer your questions and address your concerns, but you will also need to contact your insurance company to clarify your coverage.

The following questions will help you sort out your insurance coverage and help you plan for the expenses of transplantation.

Questions for your insurance company
•What part of the transplant cost is covered?
•How does this apply to my deductible?
•What is the cap on my insurance coverage?
•What happens if my financial coverage runs out?
•How can I cut down on insurance expenses to make sure my coverage lasts as long as I need it?
•How will a change in my job status affect my insurance?
•What would the increase be in my deductible?
•What pre- and post-transplant tests are covered?
•Do I need to go to a certain facility for these tests to be covered?
•Does my plan cover the expenses incurred by my organ donor?
•Are assistive breathing devices covered by my insurance plan?
•Are expenses for food, housing and transportation covered while I wait for my transplant?
•How much coverage will I receive for post-transplant medications?
•What is the co-pay amount?
Questions to ask your transplant financial counselor and transplant coordinator:
•What financial coverage is accepted by the hospital (such as Medicare, Medicaid, private insurance)?
•How much will the transplant cost?
•How much will I have to pay?
Transplant-related expenses to consider:
•Loss of income due to leave of absence from work
•Child care (if appropriate)
•Transportation to and from the Cleveland Clinic Transplant Center for you and your support person
•Emergency visits to the Transplant Center
•Parking expenses for visits to the Transplant Center
•Accommodation expenses or temporary housing expenses associated with being accessible to the Transplant Center (for you and family members)
•Long-distance telephone expenses if relocation is necessary (to be more accessible to the Transplant Center)
•Food expenses for family support person
•Post-transplant medication costs
•Post-transplant follow-up tests and appointments

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