Billing

Question:   Does CHI St. Luke's Health offer cash discounts for prompt payment?
Answer   No, there are no such discounts available. We will work with each patient to develop a payment plan based on the amount due and the patient’s family income level.
Question:   How can I obtain financial assistance to cover my bill?
Answer  

CHI St. Luke's Health offers financial assistance based on the patient’s family income level. Please contact us at 713-400-5750 or toll-free at 1-888-400-5750 for more information.

Question:   How long will it take to get things settled with the insurance company?
Answer   Generally, it takes from 45 to 60 days to obtain payment from an insurance carrier. However, there may be cases in which settlement takes longer.
Question:   I received a notice that my insurance company has paid on my bill -- but I can't understand how they calculated their payment amount. Do you know?
Answer   If we have received any such information from your insurance company, we'll be glad to share it with you. However, for answers to any questions about insurance payments, deductibles, or co-payments, you need to check with your insurance company.
Question:   What billing or insurance information will I receive from CHI St. Luke's Health?
Answer  

After your insurance has paid, we'll provide you with a monthly statement of your account. Please contact our office at the phone number provided on the statement to request an itemized bill should you need further detail of the services provided. 

Question:   Why am I getting bills from physicians?
Answer  

Each physician who provides professional services will send you a separate bill from his or her office. These physicians will include:

  • your own physician
  • other physicians who conducted tests and procedures
  • consulting physicians chosen by your primary physician

These physicians may include specialists in anesthesiology, cardiology, emergency medicine, nuclear medicine, pathology, radiology, or urodynamics. You will be responsible for paying these bills as well as your CHI St. Luke's Health bill.

If you have questions about these bills, please call the physician's office listed on the billing statement.

Question:   Will CHI St. Luke's Health accept monthly payments on the portion I owe?
Answer   Yes, monthly payments are acceptable, but they must be based on an approved payment plan. We will be glad to discuss the arrangements with you, so that the plan is mutually satisfactory for all involved.
Question:   Will CHI St. Luke's Health send my hospital bill to my insurance company(ies), or will I have to do it?
Answer  

We will gladly file your bill with any insurance companies that you have authorized and provided in a timely manner as most insurance plans have a limited time in which charges can be submitted. Please ensure that you give us complete and accurate information for the insurance company, including addresses, policy numbers, etc. Also, when you pre-register, be sure to sign an authorization form that permits us to file your bill with these companies. 

Careers

Question:   Are part-time employees eligible for benefits?
Answer  

Yes. Please visit the Benefits page for more information.

Question:   Do you offer a standard benefit package?
Answer  

Please refer to Benefits page.

Question:   Does it look bad to apply for multiple positions?
Answer   No, we encourage you to apply for as many positions as interest you for which you meet the minimum qualifications.
Question:   Generally, how does the CHI St. Luke’s Health recruitment process work?
Answer   A recruiter will contact you if you meet the minimum qualifications and the desired skill set.
Question:   How do I check the status of my application?
Answer  

Login to your profile at www.healthiercareers.com and review pending applications for “Active” or “Not Selected” status. 

Question:   How will I know if I have not been selected for a position?
Answer   Candidates will receive communication from the HR Recuiter, by email or phone, regarding application decisions.
Question:   I applied for a position, and I meet the minimum qualifications. Why wasn’t I contacted for an interview?
Answer   Other candidates may have more applicable experience for the role.
Question:   I’m not from the Houston area. Is relocation assistance offered?
Answer   Many of our positions offer relocation assistance for candidates; however, please discuss with the recruiter who contacts you.
Question:   If I experience problems with the application process, may I can contact someone?
Answer   Please contact the Human Resources office at the appropriate CHI St. Luke’s Health location.
Question:   May I schedule an interview? May I speak directly with a recruiter? When will the recruiter call me?
Answer   If you meet the qualifications for the position, a recruiter/hiring manager will contact you. Unfortunately, we are unable to transfer you directly to a recruiter.
Question:   Where/how do I apply?
Answer  

Any computer will access our Career/Job search engine site at www.healthiercareers.com. Once there, create a profile and apply for the position(s) that interest you.

Clinical Pastoral Education (CPE)

Question:   Do you have openings for Supervisory Education?
Answer  

Not at this time. Several nearby centers are offering Supervisory Education. For more information, visit ACPE at www.acpe.edu.

Question:   I want to be a chaplain. Do I need CPE?
Answer  

The Association of Professional Chaplains (www.professionalchaplains.org), the National Association of Catholic Chaplains (www.nacc.org) and the National Association of Jewish Chaplains (www.najc.org) and other organizations certify chaplains. The American Association of Pastoral Counselors (www.aapc.org) trains and certifies pastoral counselors. Some CPE is required as a pre-requisite. Interested individuals should contact these organizations directly about requirements.

Question:   What are the essential elements of a CPE unit?
Answer  
  • Actual practice of ministry to persons
  • Detailed reporting and evaluation of that practice
  • Pastoral Supervision
  • Process conception of learning
  • Theoretical perspective on all elements of the program
  • Small group of peers in a common learning experience
  • Specific time period
  • Individual contract for learning consistent with the objectives of CPE
  • CPE program conducted under the auspices of an ACPE certified supervisor (faculty) attached to an ACPE-accredited CPE center
Question:   What is typical day in the program?
Answer  
  • Summer interns and residents begin with the departmental daily meeting. Mornings are usually spent in seminars; typically, students visit their clinical divisions in the afternoons. 
  • Extended students meet for education one day a week and schedule their required clinical hours in conjunction with their supervisor. 
  • All CPE students participate in an on-call rotation for St. Luke’s Medical Center as well as Texas Children’s Hospital. Students who are on-call remain in the hospital overnight. Additional on-call information will be provided during your interview and orientation.
Question:   Who can enroll in CPE at Baylor St. Luke’s Medical Center?
Answer  

Individuals are eligible who, through a written application and an admissions interview, have demonstrated the ability to participate in CPE and work toward its Objectives and Outcomes. 

  • Educational Requirements: Board certification in chaplaincy requires an undergraduate degree and graduate level theological degree. Students entering residency should document their progress toward this outcome.
  • Ordination or Endorsement Requirements: Board certification in chaplaincy requires ordination or endorsement with a student’s faith tradition. Applicants should document their progress toward this requirement. 
  • Other Commitments: Due to the demands of the program, Residents and Summer students are discouraged from intense outside commitments while enrolled. Extended students sometimes remain employed while completing their unit requirements.

Heart Transplant

Question:   How do I start the evaluation process?
Answer   In most cases, your personal cardiologist will make the first inquiry about a transplant. Information that will be required from your cardiologist includes your insurance information.
Question:   How long will I be in the hospital after my surgery?
Answer  
  • After your transplant, the recovery time varies.  Some patients may be discharged from the hospital within 7-10 days and others require longer recovery times.
  • If you live out of the Houston area, you are typically required to stay in the area for approximately three months.
Question:   If I am accepted for transplant, how long will I have to wait?
Answer   If you are accepted for transplantation, you will be placed on a national computer list of active candidates waiting for a suitable donor. Recipients are chosen according to a complex set of criteria, including blood type, body and organ size, medical condition, and length of time on the waiting list. The United Network for Organ Sharing (UNOS) coordinates the equitable sharing of organs throughout the United States and oversees all donor centers and procurement agencies.

The waiting period can be several months to several years, while the transplant team searches for the appropriate heart for you. The transplant coordinators must be able to locate you 24 hours a day and you must be able to reach the hospital within a reasonable amount of time.
Question:   What are my responsibilities while waiting for transplant?
Answer  

While on the transplant list, you must maintain active medical insurance. Failure to do so may impact your ability to receive a new heart.

You must notify the transplant center if there are any changes in:

  • Insurance
  • Address or phone number
  • Medical condition
  • Infections
  • Surgeries/ hospitalizations
  • Blood transfusions
Question:   What happens when I get to the hospital for surgery?
Answer  

After admission, the patient will have blood work and may have an intravenous line placed to monitor the heart pressures. Unfortunately in some cases, the surgery has to be canceled after you have arrived at the hospital.  Some reasons are:

  • Poor heart function noted after visualizing the donor heart
  • Infection
  • Additional medical problems
Question:   What is congestive heart failure?
Answer  

Congestive heart failure (CHF) happens when the heart’s weak pumping action causes a buildup of fluid called congestion in the lungs and other body tissues.  Those at risk for developing CHF have the following:

  • Coronary heart disease
  • Cardiomyopathy
  • Previous heart attacks
  • High blood pressure
  • Irregular heartbeat
  • Congenital heart defects
  • Heart valve disease
  • Alcohol and drug abuse
Question:   What is the process like once a heart is found for me?
Answer  

When a potential donor is found, the coordinator will call to notify you (it is very important to keep us aware of any change in address or phone number).  If there is no answer, the coordinator will then page you. Once contact is made, the coordinator will instruct you on where to report and ask you not to have anything else to eat or drink prior to the transplant.

When you come for surgery, please remember to bring:

  • A current medication list
  • A list of your drug allergies
  • Current health insurance information (your most recent insurance cards)
Question:   What should I expect during the evaluation process?
Answer   A standard set of tests including labs and radiology imaging give a clear picture of your overall health status. They also help to identify potential problems before they occur. We try to determine whether or not transplantation is truly the best option for you.
Question:   What tests should I expect to have done during my evaluation?
Answer  
  • Abdominal Ultrasound - Examines the kidneys, liver, and gallbladder for the presence of cysts, stones, or other abnormalities.
  • Blood tests - Blood test help assess your overall physical condition.
  • Cardiac tests - These tests will assess your heart function and will include an echocardiogram, electrocardiogram (EKG or ECG), cardiac catherization, and a stress test.
  • Chest X-ray and CT scan of the chest- These tests assesses the size of your heart and any lung abnormalities.
  • Colonoscopy - A procedure to screen for colon cancer on anyone over age 50
  • Gynecological Exams - All women will need a gynecological exam within the last year
  • Mammogram - This test is required for all women over the age of 40.
  • Physical Exam - This gives the doctor an overall picture of your condition.
  • Pulmonary function study - This test will identify any lung problems that need to be addressed prior to transplant.
  • TB Skin testing- A small amount of solution is injected under the skin on your forearm to determine if you have been exposed to tuberculosis. Everyone is different, therefore, every evaluation will be tailored to each individual.
  • Interview with the financial counselor, dietician and social worker – This is to identify potential post transplant problems to develop a plan of action prior to the transplant
Question:   What treatment options are available for heart failure?
Answer  
  • Medical Therapy
  • Biventricular Pacemaker Device
  • Left Ventricular Assist Device
  • Orthotopic or heterotopic heart transplantation
Question:   What will be expected of me after transplant?
Answer  
  • You will have to follow up frequently for lab work and biopsies initially. Biopsies are done to determine if there is any rejection and can be done as an outpatient procedure after you are discharged from the hospital. We will perform many biopsies during your first year after transplant.  You will need to have lab work drawn every one to two weeks for the first three months after transplant.
  • There are several factors that will help you keep your new heart healthy. It will be important to follow a healthy lifestyle.  You will need to exercise regularly, maintain a healthy diet, and keep a weight that is appropriate for your body frame.  You will be expected to help your transplant team monitor your care by keeping records of your blood pressure, blood sugar, weight, temperature and pulse.
Question:   What will my surgery be like?
Answer  
  • The surgery usually takes 4-6 hours
  • The incision will be in the middle of your chest
  • A breathing tube will be inserted to assist you with breathing while you are sedated
Question:   When will I be able to return to work or school?
Answer   This time will vary for each person. Ideally you should be able to return to work or school about three months after transplant if your condition is stable. Most patients are able to return to a healthy level of normality about this time.
Question:   Who can be considered for heart transplantation at Baylor St. Luke’s Medical Center?
Answer   The only absolute contraindications to transplant are malignancy not cleared by an oncologist, hepatic cirrhosis, severe chronic obstructive pulmonary disease, and severe elevated pulmonary vascular resistance and untreated psychosis.
Question:   Who determines if I am a transplant candidate?
Answer   Medical Review Board. When your evaluation is complete, your case will be presented to the Board. The Medical Review Board consists of transplant cardiologists, transplant surgeons, transplant coordinators, dieticians, social workers, and financial counselors. Their goal is to determine the best treatment option for you and they will determine if you are a candidate for transplant.

Kidney Transplant

Question:   Do I have to go back to the hospital after transplant?
Answer   (Clinics and labwork) – You will have to follow up with your nursing and nephrology staff after your transplant to make sure your new kidney remains healthy. Clinic schedules vary according to the nephrologist managing your care. Typically, patients are seen every week for the first month post transplant, and then reduce in frequency over time. You will need to have lab work done before each clinic visit. Any additional testing to monitor your health and kidney function will vary from patient to patient. Tests may include renal scans, ultrasounds, and kidney biopsies. Typically, patients are seen by the nephrologist at St. Luke’s for one year after their transplant, and then are transitioned back to the nephrologist’s private office.
Question:   Healthy lifestyle after transplant
Answer   There are several factors that will help you keep your new kidney healthy. It is important to maintain a healthy lifestyle after transplant. You will need to exercise regularly, maintain a healthy diet, and keep a weight that is healthy for your body frame. You will need to take your medications regularly and report any problems or side effects to the transplant team. You will also need to come to your scheduled clinic visits. You can help your transplant team monitor your care by keeping records of your blood pressure, blood sugar, weight, temperature and pulse.
Question:   How can donated kidneys be obtained?
Answer  

A kidney transplant can be obtained two ways:

  • Deceased donation – Patients most commonly receive a kidney from someone who passed away and had previously agreed to give the gift of life by registering as an organ donor or had family members who agreed to donate the deceased’s organs.
  • Living renal donation – A relative, friend, or loved one may offer to donate a kidney to you. Learn more about our Living Kidney Donation Program. Download and complete our Kidney Transplant Referral Data Sheet
Question:   How can I be evaluated or listed for transplant?
Answer  

Patients can self-refer themselves for transplant evaluation by calling 832-355-4100. You will be asked a few questions including:

  • Demographics/insurance information
  • Dialysis information
  • Name and phone numbers of current doctors
  • Short medical history

You can also download and complete our Kidney Transplant Referral Data Sheet (pdf). All information on the application must be complete before the team can begin processing the referral. Your dialysis nurse or social worker may be able to assist you with completing the application.

Question:   How do I determine if I am a candidate for a transplant?
Answer   Although there are many different factors as to why a patient is or is not eligible for a transplant, we currently do not transplant patients with the following occurrences: active malignancy, HIV positive, pregnancy.
Question:   How long will I be in the hospital?
Answer  
  • After your transplant, you are typically in the hospital 4 to 6 days. Follow-up appointments are in the Transplant Clinic.
  • If you live out of the Houston area, you are typically required to stay near St. Luke’s for one month post transplant so we can monitor your kidney function and drug levels closely.
Question:   How much will my medications cost?
Answer   Medication expenses vary according to your health insurance and any supplemental funding. If you need more assistance, please see the “Financial Considerations” tab.
Question:   Return to work or school
Answer   You may return to work or school about 4 to 6 weeks after transplant, depending on your kidney function and your response to medication. Most patients are able to return to a healthy level of normality at this time.
Question:   What are my responsibilities while waiting for transplant?
Answer  

While on the transplant list, you must maintain active medical insurance. Failure to do so may impact your ability to receive a kidney.

You must notify the transplant center if there are any changes in:

  • Insurance
  • Dialysis unit
  • Address or phone number
  • Medical condition
  • Infections
  • Surgeries/hospitalization
  • Blood transfusions
Question:   What are the causes of renal failure?
Answer  

Kidney failure may be caused by one or more of the following:

  • Diabetes
  • Hypertension
  • Chronic glomurulonephritis
  • Polycystic kidney disease
  • Lupus
Question:   What happens if it is determined I am a transplant candidate?
Answer   If you are accepted for transplantation, you will be placed on a national computer list of active candidates waiting for a donor. Recipients are chosen according to a complex set of criteria, including blood type, body and organ size, physical condition, age, and length of time on the waiting list. The United Network for Organ Sharing (UNOS) coordinates the equitable sharing of organs throughout the United States and oversees all donor centers and procurement agencies.

The waiting period can range from several months to several years. Many factors are considered when matching donor kidneys to recipients. Some of the factors that affect wait time are body size, age, and antibody level.

Below are approximate wait times for our area based on the recipient’s blood type:

O blood type – 2.5 years
A blood type – 1.5-2 years
B blood type – 2 years
AB blood type – 1.5 years

The transplant coordinators must be able to contact you 24 hours a day and you must be able to get to the hospital within a reasonable amount of time once a kidney becomes available. When a donor kidney is found, you will be notified immediately and given instructions.
Question:   What happens when I get to the hospital?
Answer  

After admission, you will have a thorough physical examination, including blood work, chest x-ray, and EKG. Unfortunately, in some cases the surgery must be postponed and you will be sent home. The reason for canceling the surgery might be for one or more of the following reasons:

  • Infection
  • Additional medical problems
  • The donor kidney shows signs of poor function
  • A problem is identified with match between the donor and recipient

If the surgery is canceled, you will remain on the transplant list.

Question:   What is the process when a kidney is found?
Answer  

When a potential donor is identified, the coordinator will call (it is very important to keep us aware of any change in address, phone number, or dialysis unit) with specific instructions, and give you a timeline for your care and transplant.

When you are instructed to come to the hospital the coordinator will give you a time and place to report, and will let you know when to stop eating and drinking.

When you come for surgery, please bring:

  • Current medication list
  • Drug allergies list
  • Current health insurance information (current insurance cards)
Question:   What is the workup process like?
Answer  

A standard set of tests including labs and x-rays give a clear picture of your overall health status. They also help to identify potential problems before they occur. We can determine whether or not transplantation is truly the best option for you. The tests during the evaluation include:

  • Blood tests - Assesses your overall physical condition.
  • Tissue typing - A special blood test that helps find a donor kidney that matches and provides valuable information about your body's immune system
  • Colonoscopy – Screens for colon cancer for anyone over age 50.
  • Chest X-ray  - Assesses the size of your heart and checks for lung abnormalities
  • Voiding cystourethrogram (VCUG) - Assesses the function of the lower urinary tract
  • Abdominal US - Examines the kidneys, liver and gallbladder for cysts, stones or other abnormalities
  • TB Skin testing – Tests for exposure to tuberculosis.
  • Gynecological exam – All women need a gynecological exam within the last year. Mammograms are also required for all women over age 40.
  • Pulmonary function studies – Persons with a history of lung disease or tobacco use will undergo pulmonary (lung) function studies.
  • Cardiac tests – Assesses your heart function via an echocardiogram and electrocardiogram (EKG or ECG). A stress test and a cardiac catheterization are done if needed.
  • Physical examination – Assesses your overall condition

Because everyone is different, every evaluation is tailored to evaluate each person’s specific needs.

Medical Review Board: When your evaluation is complete, your case is presented to the Medical Review Board (MRB). The MRB consists of nephrologists, transplant surgeons, transplant coordinators, a dietician, social workers, and a financial counselor. The MRB will weigh the risks and benefits of dialysis vs. transplantation to determine which method is best for you. You will be notified of the MRB’s recommendation by one of the transplant coordinators.

Question:   What medications will I be on after transplant?
Answer  

Post transplant, you will be on several different medications.

  • Immunosuppression medications – These medications keep your body from fighting off your new organ. They may include: Neoral, Prograf, Cellcept, Myfortic, Rapamune, and Prednisone
  • You may be on other medications to control blood pressure, glucose, manage cholesterol, antibiotics and antivirals, diuretics, iron supplements, and vitamins. You may also go back on any pre-transplant medications to manage any other pre-existing conditions.
Question:   What will my surgery be like?
Answer  
  • The surgery normally takes 3-4 hours
  • The incision will be in the lower abdomen/pelvis area and is usually 6-10 inches long

Liver Transplant

Question:   How do I start the evaluation process?
Answer   The evaluation process begins with an appointment with the hepatologist (liver disease specialist). The hepatologist determines the medical appropriateness of an individual’s need for a liver transplant. You will also meet with the liver transplant surgeon. The surgeon will discuss the risks and benefits of liver transplantation, possible complications after liver transplant, and types of liver donors available. You will meet with the financial counselor to discuss the costs of a liver transplant as well as the costs related to caring for your liver transplant. They will discuss your insurance coverage as well as costs not covered by your insurance. They will discuss options such as fund raising to help cover the costs not covered by your insurance company. You will also meet with the transplant coordinator. This meeting includes education regarding the transplant and listing process and the pre transplant and post transplant responsibilities of the patient. The transplant coordinator is your primary contact person. The dietician will review your current diet habits and recommend any needed changes. They will also assist you in maintaining proper nutrition and weight. You will also meet with a social worker to evaluate your ability to deal with the transplant regimen while waiting for a transplant and after you receive your transplant. They will also assist you in identifying your support group.
Question:   How long will I be in surgery?
Answer   The surgery normally takes 3-5 hours.
Question:   How long will I be in the hospital after my surgery?
Answer   After your transplant, you are typically in the hospital for 5 to 7 days. After discharged from the hospital you will be seen in the Transplant Clinic for follow up care. If you live out of the Houston area, you are typically required to stay near St. Luke’s for one month post transplant. This way, we can monitor your new liver function and medication levels closely.
Question:   Is there a waiting period for transplant?
Answer  

If you are accepted for transplantation, you will be placed on a national computer list of active candidates waiting for a donor.  Recipients are chosen according to a complex set of criteria, including MELD Score (Model for End Stage Liver Disease) blood type, and length of time on the waiting list. Recipients are chosen primarily on the basis of medical urgency within each ABO blood group. Waiting time is only a factor when patients have the same MELD score.   The United Network for Organ Sharing (UNOS) coordinates the equitable sharing of organs throughout the United States and oversees all donor centers and procurement agencies.

MELD SCORE -  is a numerical scale used for adult liver transplant candidates. The range is from 6 (less ill) to 40 (gravely ill). The individual score determines how urgently a patient needs a liver transplant. The number is calculated using your most recent laboratory tests. For additional information please log on to www.unos.org.

Lab values used in the MELD calculation:

  • Bilirubin, which measures how effectively the liver excretes bile;
  • INR (formally known as the prothrombin time), measures the liver’s ability to make blood clotting factors;
  • Creatinine, which measures kidney function. Impaired kidney function is often associated with severe liver disease.
Question:   What are my responsibilities while waiting for transplant?
Answer  

While on the transplant list, you must maintain active medical insurance.  Failure to do so may impact your ability to receive a transplant. You must notify the transplant center if there are any changes in:

  • Insurance
  • Address or phone number
  • Support Team
  • Medical condition
  • Infections/ fevers
  • Surgeries/hospitalization
  • Medical deterioration

All patients must follow prescribed treatment regimen (diet, medication, clinic appointments and lab work and scheduled testing)

Question:   What are the different causes of liver failure?
Answer  

Liver failure may be caused by one or more of the following:

  • Hepatitis B & C
  • Autoimmune Hepatitis
  • Cirrhosis
  •  Alcoholic Cirrhosis
  • Primary Biliary Cirrhosis
  • Cryptogenic Cirrohosis
  • Primary Sclerosing Choalangitis
  • Hepatocellular Carcinoma
  • Wilson’s Disease
  • Primary Hemochromatosis
  • Non Alcoholic Steatohepatitis ( NASH)
  • Budd- Chiari Syndrome
  • Acute Liver Failure
  • Metabolic Disease
Question:   What happens when I get to the hospital?
Answer  

After admission, the patient will have a thorough physical examination, including blood work, chest x-ray, and EKG. Unfortunately, in some cases, the surgery must be postponed and the patient sent home again.  We cannot always predict these cases, but postponing the transplant in these instances are in your best interest.  Some cases may include:

  • Infection
  • Additional medical problems
  • The donor liver shows signs of poor function
  • A problem is identified with match between the donor and recipient
Question:   What is my expected follow up care after hospital discharge? (Clinics and labwork)
Answer   You will have to follow up with your liver transplant team after your transplant to make sure that your new liver remains healthy. Typically, patients are seen every week for the first month post transplant, and then will reduce in frequency over time. Please expect to have frequent lab work done. Any additional testing to monitor your health and liver function will vary from patient to patient. Tests may include abdominal scans, ultrasounds, and liver biopsies.
Question:   What is the process like when a liver is found for me?
Answer   When a potential donor is found, the coordinator will call you (it is very important to keep us aware of any change in address, phone number). When we call you, the coordinator will give specific instructions and notify you of a timeline for your care and transplant. When you are instructed to come to the hospital the coordinator will give you a time and place to report and will let you know when to stop eating and drinking.
Question:   What is the workup process like?
Answer  

There are many different tests and consults that will be performed to determine if you are a suitable candidate for liver transplantation. Below is a list of some of the tests that will be ordered as part of your evaluation. Other tests or consults may be ordered based on the results of these tests.

  • Blood/Urine/Stool tests - Blood tests and specimen collection to help assess your overall physical condition.
  • Colonoscopy – A procedure to screen your colon.
  • Endoscopy- A procedure to screen your upper gastrointestinal tract.
  • Chest X-ray - The test assesses the size of your heart and any lung abnormalities
  • MRI or CT Scan of Abdomen - Examines the kidneys, liver, and gallbladder for the presence of cysts, stones, lesions, portal vein patency, ascites, and or other abnormalities.
  • TB Skin testing - A small amount of solution is injected under the skin on your forearm to determine if you have been exposed to tuberculosis. 
  • Gynecological exam – All women will need a gynecological exam within the last year. Mammograms are also required for all women over age 40.
  • Pulmonary function studies - If you have a history of lung disease or tobacco use, your transplant work-up may include pulmonary (lung) function studies.
  • Cardiac tests – These tests will assess your heart function and will include an echocardiogram, and electrocardiogram (EKG or ECG).  A stress test and a cardiac catheterization are done if indicated.
  • Physical examination (gives the doctor an overall picture of the patient’s condition).

Everyone is different; therefore, every evaluation will be tailored to evaluate specific patient’s needs. Medical Review Board: When your evaluation is complete, your case will be presented to the Medical Review Board (the MRB).  The MRB consists of a multidisciplinary team of hepatologists, transplant surgeons, transplant coordinators, a dietician, social workers, financial counselor and consulting physicians.  The purpose of the MRB is to discuss each evaluant case by case and to determine possible candidacy. Recommendations may be made by the MRB prior to making a final decision for transplant eligibility. All evaluants will be notified via certified mail and contacted by their assigned coordinator of the MRB outcomes and recommendations.

Question:   What medications will I be on after transplant?
Answer   Post transplant, you will be on several different medications.

Immunosuppression medications – These medications will keep your body from fighting off your new organ. These may include: Neoral, Prograf, Cellcept, Rapamune, and Prednisone.

You may be on other medications to control blood pressure, Insulin, antibiotics and antivirals, diuretics, and vitamins. You may also go back on any pre-transplant medications to manage any other preexisting conditions.
Question:   When you come for surgery, please remember to bring:
Answer  
  • A current medication list
  • A list of your drug allergies
  • Current health insurance information (your most recent insurance cards)
Question:   Why would I not be eligible for a liver transplant at BSLMC?
Answer  
  • Significant or advanced cardiac, pulmonary, nervous system or other systemic diseases, except where dual organ transplants are being considered (i.e. liver/lung, liver/kidney, liver/heart)
  • Systemic infection
  • Hepatocellular carincoma with extrahepatic (outside the liver) spread or vascular involvement
  • Presence of malignancies outside the liver with the exception of special cases such as neuroendocrine tumors
  • Acute severe hemodynamic compromise at the time of transplantation if accompanied by compromise or failure of one or more vital organs. Severe compromise is defined by the requirement of inotropic agents to maintain systolic blood pressure >90 mm Hg or pulmonary hypertension with a mean of >33 mm Hg
  • Active alcohol or drug abuse
  • History of behavior pattern or psychiatric illness considered likely to interfere significantly with compliance
  • Lack of sufficient social support to allow 24 hour care
  • Portal vein thrombosis
  • Patients with uncontrolled severe comorbid medical conditions
  • Obesity (BMI >40), which may result in technical or medical complications in the peri-operative and post operative periods

Living Kidney Donation

Question:   How can I become a living renal donor and what are the qualifications?
Answer  

To be considered a potential living donor you must: 

  • Be 18 years of age or older;
  • Be free of uncontrolled high blood pressure, diabetes (including some instances of gestational diabetes), HIV, sickle cell disease, current malignancy or infection;
  • Not have had any heart attacks within one year;
  • Not have evidence of Hepatitis B;
  • Be in good general health, with acceptable kidney function;
  • Have a BMI of 35 or under;
  • Have acceptable anatomy for donation;
  • Not be pregnant;
  • Understand the risks, benefits and complications associated with donation;
  • Be willing to donate a kidney without monetary gain or psychological coercion;
  • Be willing to accept all blood and blood products the physician feels medically necessary;
  • Have a compatible blood and tissue type matching to the recipient as determined by blood testing;
  • Compatible blood types:
 

Recipient's Blood Type

Donor's Blood Type

 

O

O

 

A

A or O

 

B

B or O

 

AB

A, B, AB or O

  • Not be incarcerated;
  • Not be an undocumented resident of the USA;
  • Be willing to consent for full disclosure of medical information;
  • Complete the renal donor evaluation to determine if you are a suitable donor. The purpose of these tests and consultations is to make absolutely certain you will not be harmed by donating.
Question:   How does living donation affect the donor?
Answer  

Following kidney donation, the remaining kidney grows bigger and functions much harder. After the donor recovers from surgery, the donor can continue to live a normal life. The recovery for the laparascopic procedure is usually 2 to 3 weeks while the recovery for the open nephrectomy may take 4 to 6 weeks.  

After being discharged from the hospital, the donor should observe the following:

  • Avoid lifting more than 10 pounds for the first 6 weeks;
  • Increase fluid intake and walking to avoid constipation related to pain medications;
  • Take pain medications as prescribed by the physician;
  • Avoid NSAID’S such as Aleve, Nuprin, Advil , Motrin and Ibuprofen;
  • Have an adequate follow up with the doctor following laboratory tests;
  • Report any concerns to the transplant physician or coordinator.
Question:   What are my rights as a donor?
Answer   A potential living donor has the right to change his or her mind at anytime and the decision will be respected by the transplant team. The results of the evaluation are strictly confidential and are not shared with anyone except the potential donor.
Question:   What are the advantages of living donation?
Answer  

A living donor kidney transplant has many advantages as compared to a transplant from a deceased donor.

  • Donors can be tested as soon as the recipient is actively listed, negating the prolonged wait for a deceased donor.
  • A kidney from a living donor typically works better and has a longer life span.
  • The surgery can be pre-scheduled, avoiding the uncertainty and stress of being on the waiting list.
  • May prevent the need for dialysis and the complications associated with kidney failure.
  • Living donor kidneys typically begin to function immediately.
  • For some patients with kidney failure, a living donation may be life saving.
  • Choosing to donate a kidney is a gift of life.
Question:   What are the potential risks involved in living donation?
Answer   Donating an organ requires major surgery. There are risks associated with the surgery and potential complications from the general anesthesia. Modern science and current medications used in surgery make the risk of complications very low. Many complications are minor and get better on their own. In some cases the complications are serious enough to require another surgery or medical procedure.

Some of these medical risks may include allergic reaction to the general anesthesia, bleeding, infection, injury to structures in the abdomen, and pressure sores on the skin or burns caused by the use of electric equipment during surgery. Damage to nerves may occur and death from kidney donation is very rare. Psychosocial risks may include depression, anxiety, post traumatic stress disorder and feelings of guilt.
Question:   What are the surgical techniques available to remove the donor’s kidney?
Answer   Laparascopic surgery is a specialized, less invasive procedure in which the surgeon places a small wound in the donor’s abdomen for a camera and surgical instruments and to remove the kidney. Laparascopic nephrectomy has better cosmetic results, usually has a quicker recovery period and a more rapid return to normal activities. Pain medications are generally needed for a shorter time.

Sometimes the donor is not a candidate for laparascopy because of the donor’s anatomy or surgical history. In this case an open approach, called Open Nephrectomy, is used to remove the kidney. With this procedure, the surgeon makes an incision in the side or flank area which is larger than what is made during the laparascopy. There is generally more pain and a longer recovery associated with this procedure.
Question:   What does the evaluation consist of?
Answer  
  • Living Donor Coordinator/Independent Living Donor Advocate Consult: This meeting is intended to fully inform the potential donor about the kidney donation and the transplant process.
  • The doctor carefully assesses the function of the kidneys and the safety of donating.
  • Transplant Surgeon: The surgeon discusses the appropriateness of donating a kidney, the risk of surgery and possible complications after donation.
  • Social Worker Consult: A psychosocial assessment is conducted to evaluate the potential donor’s readiness to donate a kidney.
  • Registered Dietician Consult: The dietician may perform a nutritional assessment and provide nutritional education.
  • Health exam: Several tests are done to determine if the potential donor is a suitable candidate including:
    • Laboratory testing to screen the immunity for presence of viruses. Blood and urine tests help determine if all organs, including the kidneys, are healthy and functioning properly 
    • A chest X-ray to help identify any problems with the lungs and an EKG (electrocardiogram) to assess heart function.
    • A CT scan to examine the abdomen and pelvis area and to determine which of the donor’s kidneys is best for donation.
    • A Pap smear exam and mammogram for women over the age of 40 to evaluate any presence of malignancy.
    • A PSA for all men over the age of 50 to evaluate the prostate.
Question:   Who can be a living donor?
Answer  

Donation does not have to be from a blood relative. Our living donor program is available to anyone who is medically and psychologically suitable for donation. A living donor can be:

  • Family, friend, spouse or coworker;
  • A directed altruistic donor (someone who donates a kidney to a specific person with whom he or she might be acquainted);   
  • A nondirected altruristic donor (someone who donates a kidney to a non-specific person on the waiting list);
  • A donor through the Paired Donor Exchange program or “Kidney swap.” This is a person who is willing to donate but is incompatible to the intended recipient. St Luke’s Hospital, sponsored by the Alliance for Paired Donation program, offers the donor and the recipient the opportunity to match one incompatible donor/recipient pair to another pair. In other words, the two donors donate to the other’s recipient. For more information, you may reach the living donor coordinator at 832-355-7061 or go to PairedDonation.org.
Question:   Who pays for the renal evaluation and the surgery?
Answer  

In most cases the cost of the renal donor evaluation is paid by the recipient’s insurance and there is no cost to the donor. However, the donor is not reimbursed for missed days at work, travel or lodging. Donors should look into whether their short term disability insurance covers the recovery. The National Living Donor Assistance Center may provide financial support to persons who want to donate, but cannot otherwise afford travel and expenses associated with donation. For more information on how to apply, please visit LivingDonorAssistance.org.

LVAD Program

Question:   LVAD as a Treatment Option
Answer   The FDA approved the HeartMate® LVAD for destination therapy based on results of the landmark REMATCH clinical trial that demonstrated the device nearly doubled and tripled survival at one and two years respectively, and improved quality of life in this patient group. Physicians at Baylor St. Luke’s Medical Center’s Cooley Transplant Center and the Texas Heart® Institute have implanted over 1,000 LVAD devices since 1986.

The Texas Heart® Institute at Baylor St. Luke’s Medical Center originated the laboratory and clinical research on all LVAD pumps including the HeartMate® XVE, HeartMate® II, Jarvik, and HeartWare®, and implanted the first 20 HeartMate® LVADs in the world. O.H. “Bud” Frazier, MD, and his team initiated the research which led to the REMATCH study and have implanted more of the devices than any other heart center worldwide.

If you suffer from congestive heart failure and want to know if you may be a candidate for an LVAD as a permanent implant, please contact us at 832-355-2285 or toll free at 877-685-0361.
Question:   What is an LVAD?
Answer  

Physicians at Baylor St. Luke's Medical Center Cooley Transplant Center and the Texas Heart® Institute believe that an LVAD is the first acceptable solution for long-term support of heart failure patients because it allows them to leave the hospital and return to active, productive lives.

More than 4 million Americans have congestive heart failure, a chronic condition in which the heart loses its ability to pump blood efficiently. The disease causes fatigue and shortness of breath as fluid accumulates in the lungs and tissue. Leading causes of heart failure are damage to heart muscle from coronary artery disease or high blood pressure.

LVAD is known as a left ventricular assist device because it helps the left ventricle – the heart's main pumping chamber – circulate blood throughout the body. The device consists of a pump that is implanted in the abdomen, which has an electrical cable that connects to external battery packs. The packs are worn on the shoulders and electronic controls are worn on the belt.

Baylor St. Luke’s Medical Center is among the nation’s first cardiovascular centers to offer  LVAD's – the Thoratec HeartMate® XVE, the HeartMate® II LVAD, Jarvik and HeartWare® – for destination therapy and bridge to transplant for patients that suffer from end-stage heart disease.

  • Destination Therapy is a permanent option for patients with heart failure who are not candidates for heart transplantation.
  • BTT (Bridge to Transplantation) is a treatment option in which an LVAD is used while a patient is waiting for a heart transplant.

Neuroendocrine Tumor

Question:   Are any clinical trials covered by insurance?
Answer  
The sponsoring company generally pays for pharmaceutical clinical trials.
Question:   Can I observe the review of my case by your tumor board?
Answer   No, to protect patients’ privacy, patients are not allowed to attend the tumor board because other patients’ cases also are presented.
Question:   Do you have a cardio-thoracic surgeon on the team?
Answer   Although there is not a cardio-thoracic surgeon on the rotation staff, one is available on request.
Question:   How do rotations work? Will I be seen by the same physician during each appointment?
Answer   Physicians rotate on a monthly basis. However, you will be seen by the physician assigned to you every time you have an appointment, unless you are referred to a different specialty. For example, if you initially are seen by an oncologist, but you need to be seen by a surgeon, the surgeon you see will depend on the rotation schedule at the time the referral is made. If you only need to see an oncologist, you will see the same oncologist every time you visit the clinic.
Question:   How long after my clinical work up will your tumor board review my case?
Answer   The Neuroendocrine Tumor Board meets on the fourth Tuesday of every month, at which time all new cases are presented. The length of time from your clinical work up until your case is reviewed will vary, depending on when you had your appointment.
Question:   How many years of experience do your physicians have with neuroendocrine tumor cases?
Answer   Our physicians have between 10 and 20 years of experience.
Question:   Who processes the lab work for advanced neuroendocrine tests
Answer   Quest Diagnostics processes most lab work. If you desire for Inter Science Institute (ISI) to process your labs, we require two days advance notice.