Even when heart disease has progressed to the stage that a heart transplant is the best choice for care, not every patient is a candidate to undergo such a serious procedure. Heart transplants are most successful for patients who are otherwise in good health and whose condition would improve greatly with a new heart. Each patient referred to Sutter Transplant Services undergoes a 19-step evaluation process to determine whether he or she is likely to benefit from a transplant and to ensure there are no additional health conditions that would put him or her at risk.

1. Clinic Appointment: History and physical performed by physician to identify problems and determine if a transplant is the best option for you
2. Social Work Consultation: Discussion of psych-social issues, coping mechanisms, etc.
3. Financial Consultation: Discussion of financial responsibilities, and understanding your transplant benefits
4. Transplant Teaching: To explain the transplant process, and the responsibilities and expectations after transplant
5. Echocardiogram/MUGA: To determine ejection fraction (EF), normal EF >50%; transplant EF <25%
6. Heart Catheterization and Angiogram: To determine the pressure in the lungs, pulmonary vascular resistance (PVR) and heart pressures
7. Electrocardiogram (EKG): To rule out heart rhythm abnormalities
8. Chest X-ray: To rule out lung abnormalities, and establish chest size and room available for transplanted heart
9. Carotid Doppler: To rule out blockages in the arteries to your head
10. Lower Extremity Doppler: To rule out blockages in the arteries to your legs
11. Pulmonary Function Tests (PFTs) with Arterial Blood Gases: To rule out lung disease, such as emphysema, chronic obstructive pulmonary disease, etc.
12. Cardiopulmonary Exercise Exam (CPX) (Exercise Electrocardiography): To determine your functional level
13. Blood Tests: To check for tissue typing, blood typing, HIV, hepatitis, syphilis, cytomegalo virus, toxoplasmosis, renal function, liver function, blood in stool, etc.
14. Sigmoidoscopy (if over 50 years of age): To rule out colon disease
15. Mammogram (if female over 35 years of age): To rule out breast cancer
16. Pap Test (if female over 18 years of age): To rule out cervical cancer
17. Dental Clearance: To rule out dental problems
18. Additional Testing/Consults: If any of the above show abnormalities, you may be required to undergo further testing or consultations to rule out the specific problem.
19. Return Clinic Visit to Discuss the Outcome of Your Evaluation: You may be requested to come back to the clinic several times during the evaluation for any number of reasons.

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