Carolinas HealthCare System

Heart Transplant Referrals

For Physicians

When to Refer a Patient

Cardiac transplantation represents last resort therapy. Because an outpatient transplant evaluation can take four to six weeks to complete, early referral for consideration of this treatment option is important. Patients should be referred for a transplant if they exhibit any of the following:

  • Impairment of left ventricular function
  • Patient is symptomatic on medical therapy
  • End-stage cardiac disease
  • Poor prognosis for one-year survival

How to Refer a Patient

To make a referral, you may contact our program assistant at 704-355-6649 or 800-562-5752. The heart transplant program assistant will schedule an appointment for the patient to see a heart transplant cardiologist within two weeks of the referral. Verbal or written contact will be made to the referring physician after the office visit.

Referral information should include:

  • Patient demographic information
  • Recent history and physical
  • Most recent echo report
  • Most recent cardiac catheterization report
  • Most recent right heart catheterization report
  • Recent labs
  • Medication list
  • Copy of front and back of insurance card(s)

Evaluation Process

Once a referral for cardiac transplant evaluation is received, the patient will be contacted and the evaluation process will be explained. The evaluation process includes but is not limited to:

  • Education with a certified transplant coordinator (a teaching session with the patient and primary caregiver)
  • Physical evaluation by a cardiologist
  • Pyschosocial evaluation with a Master's-prepared social worker
  • Transplant financial coordinator evaluation and counseling
  • Transplant surgeon evaluation
  • Pulmonary evaluation
  • Infectious disease evaluation
  • Right heart catheterization
  • Echocardiogram
  • Chest X-ray
  • Abdominal ultrasound
  • Mixed venous oxygenation consumption study
  • Other testing will be ordered based on the patient's medical history

It is the patient's responsibility to take care of the following:

  • Mammogram within 12 months for females over the age of 40
  • Pap smear within 12 months for females over the age of 18
  • PSA within 12 months for males over the age of 50
  • Colonoscopy or flexible sigmoidoscopy for patients over the age of 50
  • Dental evaluation within 12 months

Diabetics and ischemic cardiomyopathy patients must undergo further testing, including:

  • 24-hour urine for creatinine clearance and protein
  • Ankle-arm indices Carotid ultrasound
  • Ophthalmology evaluation
  • Nephrology evaluation
  • Endocrinologist evaluation

Once a cardiac transplant evaluation is completed, the patient is discussed at a multidisciplinary transplant conference and his or her acceptance as a transplant candidate is determined.

Once a candidate is deemed acceptable for cardiac transplantation and final insurance approval is obtained, the patient is placed on the United Network for Organ Sharing national list. Survival statistics are available at or

Wait List Maintenance

To remain on the waiting list, patients must complete:

  • An office visit with transplant cardiologist every three months or as needed
  • Lab work every three months or as needed
  • An annual mammogram and gynecologic exam
  • An annual prostate examination
  • A right heart catheterization every six months

How Organs are Allocated

Organ allocation guidelines are based on United Network for Organ Sharing and Organ Procurement Transplant Network policies that include medical criteria, as well as the equitable utilization of organs. Specifically, the current heart allocation policy considers characteristics of both the donor and the transplant candidate. A variety of factors determines who receives the organ. These factors include blood type, length of time spent on the waiting list and listing status.

Other Resources

For more information on organ donation and allocation, please visit

For more information regarding center specific data and statistics, please visit

For questions about the Heart Transplant Program, please call 704-355-6649 or 800-562-5752

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