Blog — Clinical Spanish

Spanish for heart failure clinic nurses (the patient who asks about transplant): the patient who brings a printout from the internet, the patient whose son found a hospital in Mexico that will do it in six months, and the patient who has been on the waitlist for three years

Miguel Ángel Fuentes had printed nine pages from the Mayo Clinic website the night before his routine heart failure clinic appointment. He had folded them in half and put them in his shirt pocket. He had been carrying them for a week, not sure if he was allowed to take them out.

He was 58 years old. He had been living with HFrEF, EF 20%, for fourteen months. He had followed every instruction the clinic had given him — the daily weights, the low-sodium diet, the medications taken at the same hour every morning, the symptom log his daughter had helped him set up on his phone. He had read the printout. He understood about a third of it. The statistic he had understood completely was the one that said five-year survival after transplant was better than 75%.

Nobody at the clinic had ever said the word trasplante to him.

He did not know if that meant it was not an option for him, or if it meant nobody had gotten around to it yet, or if it meant there was something about his case that made it a subject not to raise. He did not know how to ask without sounding like he was arguing with his doctors. He had put the pages back in his pocket twice before finally putting them on the exam table.

Scenario 1: The patient who brought the printout

What the printout means before you read it

A Spanish-speaking patient who arrives at a heart failure clinic appointment with a printout about heart transplant from a major academic medical center has done something specific: he has decided, alone and without guidance, to research his own prognosis and treatment options. He did not ask anyone for permission. He probably could not have said where the line was between what he was allowed to read and what was above his clearance level as a patient. He read it anyway.

The printout is not a demand. It is not a confrontation. It is a question that has not been spoken out loud yet, folded into a shirt pocket and carried through a week of not knowing whether to ask.

The nurse who receives this moment has two options. The first is to make it smaller: redirect to what the team is currently doing, explain that transplant evaluation is a complex process handled by a separate team, promise to pass along the question, and move on to the day’s intake. Miguel Ángel will put the pages back in his pocket and not take them out again for a long time. The second is to receive what the printout actually is: an opening.

Receiving the printout

Miguel Ángel put the folded pages on the exam table when the nurse entered. He said: “Encontré esto. No sé si aplica para mí.”

(I found this. I don’t know if it applies to me.)

The nurse picked up the pages, looked at them for a moment, and said: “Hizo bien en traerlos.”

(You did the right thing bringing them.)

She did not say hay que hablar con el doctor and move on. She did not say eso es algo muy complicado. She picked up the pages and acknowledged that bringing them had been the right choice. The conversation could not have happened without that sentence.

Miguel Ángel: “¿Por qué nadie me lo había dicho?”

(Why hadn’t anyone told me?)

This is the question that follows. It is not rhetorical. He genuinely did not know. The clinical answer is that transplant referral is a physician decision that involves multiple specialists and a formal evaluation process, and that heart failure nurses in a routine outpatient clinic do not typically initiate transplant discussions in the absence of a physician conversation about eligibility. This is a true answer. It does not address what Miguel Ángel was really asking, which was: does my doctor know I am thinking about this, and if so, why haven’t they talked to me about it?

The nurse said: “Probablemente nadie asumió que usted quería hablar de eso todavía — y eso fue un error nuestro. Usted tiene derecho a saber qué opciones existen.”

(Probably nobody assumed you wanted to talk about it yet — and that was a mistake on our part. You have the right to know what options exist.)

She did not overpromise. She did not say usted es un candidato. She did not say the team had been waiting for the right moment. She told him, clearly and without deflection, that the conversation should have happened earlier and that he was right to want it now.

What the nurse can say about transplant eligibility

A heart failure clinic nurse in an outpatient setting is not the person who determines transplant eligibility. That determination belongs to a multidisciplinary advanced heart failure team that evaluates renal function, pulmonary vascular resistance, body mass index, comorbidities, psychosocial support, geographic distance from the transplant center, and a set of criteria that have nothing to do with how motivated the patient is or how faithfully he has taken his medications.

What the nurse can say:

“Lo que usted leyó es correcto — para algunas personas con insuficiencia cardíaca avanzada, el trasplante puede ser una opción. Lo que yo no le puedo decir hoy es si usted sería candidato, porque eso requiere una evaluación que se hace con un equipo especial — no solo el cardiólogo, sino un equipo completo que incluye especialistas en trasplante, trabajadores sociales, y otros. Lo que sí puedo hacer es hablar con su cardiólogo hoy sobre si tiene sentido referirlo a ese equipo para empezar esa conversación. ¿Eso es lo que le gustaría que hiciéramos?”

(What you read is correct — for some people with advanced heart failure, transplant can be an option. What I cannot tell you today is whether you would be a candidate, because that requires an evaluation done with a special team — not just the cardiologist, but a complete team that includes transplant specialists, social workers, and others. What I can do is talk with your cardiologist today about whether it makes sense to refer you to that team to start that conversation. Is that what you would like us to do?)

Miguel Ángel: “Sí. Eso es lo que llevo meses queriendo preguntar.”

(Yes. That is what I have spent months wanting to ask.)

The printout stayed on the table. The nurse made a note in the chart: patient arrived with printed research about heart transplant, asked directly about eligibility, requests referral conversation with cardiologist. Informed patient that transplant evaluation involves a multidisciplinary team. Cardiology to address referral appropriateness at today’s visit.

The question that was never asked

At the end of the encounter, after the cardiologist had spoken with Miguel Ángel about the referral process, the nurse returned to the room. She asked him one more question:

“¿Había algo que le hiciera pensar que no era buena idea preguntar?”

(Was there something that made you think it wasn’t a good idea to ask?)

Miguel Ángel: “No quería que pensaran que no confiaba en ellos. Como que si pregunto, es porque creo que me están dejando algo.”

(I didn’t want them to think I didn’t trust them. Like if I ask, it’s because I think they’re leaving something out.)

The nurse: “Preguntar no es desconfiar. Es entender. Hay una diferencia.”

(Asking is not distrust. It is understanding. There is a difference.)

This is the dynamic that produces patients who carry printouts in their shirt pockets for a week without taking them out. They are not passive. They are trying not to disrupt a relationship they depend on. The clinic that makes room for questions does not create difficult patients; it creates patients who can participate in the decisions that affect their lives.

Scenario 2: The son who found a hospital in Mexico that will do it in six months

Who makes this call

Rodrigo Vega was 63 years old, a retired carpenter from Tijuana who had lived in San Diego for fifteen years. HFrEF, EF 22%, Class III symptoms. He walked into the clinic with his son Carlos, 34, who worked in tech in Chula Vista and had spent two weeks researching cardiothoracic surgery programs across the border.

Carlos had a website on his phone. The program was at a private hospital in Tijuana. The page said: evaluación en tres semanas, lista de espera: cuatro a seis meses. He had looked at the price. He had calculated the exchange rate. He had asked a coworker whose cousin had gone there for valve surgery and it had gone fine.

Carlos: “En los Estados Unidos la espera es de cinco años. Mi papá no tiene cinco años.”

(In the United States the wait is five years. My father doesn’t have five years.)

He was not wrong about the urgency. He was not wrong that wait times vary across systems. He was making a calculation out of love for his father and the only information he had.

What the nurse cannot do

The nurse cannot tell Carlos that the hospital in Tijuana is bad without seeing their outcomes data. She does not have it. She cannot tell him the six-month wait is impossible without knowing their volume and their allocation system. She does not know their system. She cannot tell him that going to Mexico is the wrong decision without knowing what the alternative looks like for a patient at Rodrigo’s status, in Rodrigo’s region, in the current UNOS allocation environment.

What she can do is help this family ask the right questions before they make a decision that cannot easily be undone.

The three questions the family needs to answer first

The nurse said: “Lo que usted encontró puede ser real — no le estoy diciendo que no. Lo que le estoy diciendo es que antes de tomar esa decisión, hay preguntas que necesitan respuesta, y yo quiero ayudarlos a hacerlas.”

(What you found may be real — I am not saying no to you. What I am saying is that before making that decision, there are questions that need answers, and I want to help you ask them.)

Carlos stopped. He had expected either dismissal or agreement. He had not expected to be taken seriously as someone trying to solve a problem.

The three questions:

Primera: “¿Cuántos trasplantes de corazón hace ese hospital por año, y cuáles son sus tasas de supervivencia a un año y a cinco años? Los programas de trasplante que son buenos tienen esos números disponibles — si no los tienen, eso es una pregunta importante.”

(First: how many heart transplants does that hospital do per year, and what are their one-year and five-year survival rates? Good transplant programs have those numbers available — if they don’t, that is an important question.)

The volume question is not bureaucratic. Heart transplant outcomes are volume-dependent. Programs that perform fewer than ten to fifteen transplants per year have meaningfully worse outcomes than high-volume centers. The website Carlos had found did not list volume. This is not unusual for small private programs, and it is not automatically disqualifying, but it is something to ask.

Segunda: “¿Tienen un programa de seguimiento post-trasplante en ese hospital — un equipo de insuficiencia cardíaca avanzada que maneja los medicamentos inmunodepresores y monitorea el rechazo a largo plazo? El trasplante no termina con la cirrugía — los medicamentos del trasplante son de por vida, y el rechazo puede ocurrir años después de la operación. ¿Quién va a manejar eso después?”

(Second: do they have a post-transplant follow-up program at that hospital — an advanced heart failure team that manages the immunosuppressant medications and monitors for rejection long term? Transplant does not end with the surgery — the transplant medications are for life, and rejection can occur years after the operation. Who is going to manage that afterward?)

This is the question Carlos had not thought about. The surgery was what he had been focused on. The surgery is the visible event. Post-transplant care — tacrolimus levels, biopsy schedules, rejection surveillance, the immunosuppression adjustments that continue for the rest of the patient’s life — is where most transplant centers invest the majority of their infrastructure. A small center in another country may perform the surgery well and have limited capacity for the decade of follow-up that follows.

Tercera: “¿Su seguro cubre algo de eso, y si la cirugía ocurre fuera de los Estados Unidos, habría un equipo aquí que manejaría el seguimiento post-trasplante? ¿Ha hablado con el equipo de trasplante de aquí sobre si recibirían a su papá como paciente post-trasplante si el procedimiento ocurrió en otro país?”

(Third: does your insurance cover any of that, and if the surgery happens outside the United States, would there be a team here that would manage the post-transplant follow-up? Have you talked with the transplant team here about whether they would take your father as a post-transplant patient if the procedure happened in another country?)

Some US transplant centers will accept post-operative management of patients whose transplants occurred abroad. Many will not, or will do so only under specific conditions. This is not a moral position — it is a clinical one. A team that did not perform the surgery does not have the operative records, the donor crossmatch data, or the intraoperative documentation that informs the first months of post-transplant care. A family that is planning a cross-border transplant needs to know, before the surgery, what their post-operative medical home will be.

What Rodrigo said

Rodrigo had been quiet through most of this conversation. He was a man who had spent thirty years building things with his hands. He had built a house in Tijuana before he left. He had built furniture that his children still used. He knew how to measure twice.

He said: “Yo solo quiero vivir para ver a mis nietos crecer.”

(I just want to live to see my grandchildren grow up.)

The nurse: “Eso es exactamente lo que vamos a intentar hacer posible. Por eso las preguntas importan — para que cualquier opción que elijan sea la opción más segura para llegar a eso.”

(That is exactly what we are going to try to make possible. That is why the questions matter — so that whatever option you choose is the safest option for getting there.)

Carlos left with a list of questions to ask the hospital in Tijuana and a request from the nurse to also speak with the social worker at the current center, who could help him understand what the US system looked like for Rodrigo specifically. He also left with the knowledge that his desire to solve this for his father was visible, was taken seriously, and was not wrong.

Rodrigo: at follow-up six weeks later, Carlos had called the hospital in Tijuana. They had told him their volume was six to eight transplants per year. They had not been able to give him five-year survival data. Carlos had not called back.

Scenario 3: Three years on the list and the fear that age is counting against him

Arturo's question

Arturo Castillo was 67 years old, a retired schoolteacher from Oxnard who had taught fifth grade for thirty-one years. HFrEF, EF 18%, on optimal medical therapy, CRT-D implanted. He had been listed for heart transplant at UCLA three years earlier, when he was 64.

He had been attending his heart failure clinic appointments every three months for three years. He had been stable enough to stay on the list, which in one sense was the goal. He had also been stable enough to watch other patients come through the waiting room who were younger, or who looked sicker, or both, and he had seen some of them stop coming, and he did not always know why.

At his appointment on a Tuesday in June, he sat down across from the nurse and said: “¿Mi edad va a contar en mi contra?”

(Is my age going to count against me?)

He had been sitting on this question for a year. He had not asked it because he was not sure he wanted to know the answer. He had asked it now because not knowing had become harder than knowing might be.

What the question is really asking

The clinical answer to the age question is this: in the UNOS allocation system, age is not a formal exclusion criterion for heart transplant. There is no number that disqualifies a patient. Patients in their late sixties who are otherwise well-maintained are listed and transplanted. The matching system uses medical urgency status — 1A, 1B, and 2 — along with compatible blood type, donor and recipient size compatibility, geographic distance from the donor, and a set of calculated factors that do not include a specific age cutoff.

The clinical answer is true. It is not what Arturo was asking.

Arturo was asking: am I still being considered, or has someone quietly decided that at 67 years old, three years into waiting, I am less of a priority than I was? He was asking whether the system still believed in him. He was asking whether, if a heart became available tonight, his name was still on the list in a way that mattered.

The nurse who hears only the clinical version of the question will give a technically accurate answer that does not touch what Arturo is actually afraid of.

The answer that addresses both versions of the question

The nurse said: “La edad no es un criterio de exclusión formal en este sistema — no hay un número que lo descalifica. Lo que cuenta es cómo está su corazón, cómo están el resto de sus órganos, y cuánto riesgo tiene la operación comparada con el beneficio esperado. A los 67 años y con la función que usted tiene, ese cálculo puede ser favorable.”

(Age is not a formal exclusion criterion in this system — there is no number that disqualifies you. What counts is how your heart is doing, how the rest of your organs are doing, and how much risk the operation carries compared to the expected benefit. At 67, with the function you have, that calculation can be favorable.)

She paused, then continued:

“Y si lo que le preocupa es si alguien ha dejado de pensar que usted es candidato — esa es una pregunta que vale la pena hacerle directamente al equipo de trasplante. No es una pregunta que yo puedo contestar por ellos. Pero yo puedo pedirle al médico que pida que lo llamen esta semana — no para una cita, sino para una llamada donde usted pueda hacer exactamente esa pregunta y escuchar la respuesta directamente de ellos. ¿Eso le serviría?”

(And if what worries you is whether someone has stopped thinking you are a candidate — that is a question worth asking directly to the transplant team. It is not a question I can answer for them. But I can ask the doctor to request that they call you this week — not for an appointment, but for a call where you can ask exactly that question and hear the answer directly from them. Would that help?)

Arturo: “Sí. Hace meses que quiero saber eso.”

(Yes. For months I have wanted to know that.)

The waiting room observation

The nurse asked: “¿Hubo algo específico que lo hizo pensar en esto ahora?”

(Was there something specific that made you think about this now?)

Arturo: “Hay una persona que viene aquí — un hombre más joven, tenía como cuarenta y pico. Lo vi varias veces. Hace dos meses que no lo veo. Y no sé si le fue bien o no.”

(There is a person who comes here — a younger man, he was maybe forty-something. I saw him several times. Two months now I haven’t seen him. And I don’t know if it went well for him or not.)

He was not asking about the other patient. He was asking about the pattern: that younger patients get called, that the waiting room turns over, and that being stable enough to keep coming back might also mean being stable enough to keep waiting indefinitely.

The nurse: “Lo que usted observa tiene lógica. El sistema le da prioridad a los pacientes que están más enfermos en ese momento — no es orden de llegada. Si alguien que lleva menos tiempo en la lista está en un estado más crítico, sube en la prioridad. Eso no significa que usted bajó — significa que ellos subieron porque su corazón empeoró más rápido. Usted está estable. A veces eso significa esperar más. Pero también significa que los medicamentos están haciendo lo que deben — que su corazón está siendo sostenido.”

(What you are observing makes sense. The system prioritizes patients who are sicker at that moment — it is not first-come, first-served. If someone who has been on the list for less time is in a more critical state, they move up in priority. That does not mean you went down — it means they went up because their heart worsened faster. You are stable. Sometimes that means waiting longer. But it also means the medications are doing what they should — that your heart is being sustained.)

Arturo took that in. He said: “¿Y el corazón que le fue a él — podría haberle tocado a mí?”

(And the heart that went to him — could it have gone to me?)

The nurse was honest: “No lo sé — eso depende del tipo de sangre, el tamaño, la compatibilidad, y la prioridad en ese momento. Lo que sí sé es que su nombre está en esa lista, y que esta semana el equipo de trasplante le va a llamar para que usted lo escuche de ellos directamente.”

(I don’t know — that depends on blood type, size, compatibility, and priority status at that moment. What I do know is that your name is on that list, and that this week the transplant team is going to call you so you can hear it from them directly.)

The transplant coordinator called Arturo on Thursday. The call lasted twenty-two minutes. Arturo was told that his listing status had been reviewed at the most recent multidisciplinary meeting, that his renal function had been monitored and remained acceptable, and that his age had not resulted in any change to his candidacy. He was asked if he had questions. He asked four. The coordinator answered all of them.

At his next clinic appointment, the nurse asked him how the call had gone.

Arturo: “Bien. No tenía que haber esperado tanto para preguntar.”

(Good. I shouldn’t have waited so long to ask.)

Three questions worth asking when a heart failure patient has not raised transplant

These three questions do not replace the clinical assessment. They create space for a conversation that patients frequently want and do not know how to start.

(1) “¿Ha estado pensando en lo que viene con el corazón — en las opciones, en el futuro — o tiene preguntas que no ha tenido la oportunidad de hacer?”

(Have you been thinking about what comes next with the heart — about options, about the future — or do you have questions you haven’t had the chance to ask?)

(2) “¿Hay algo que le hayan dicho, o algo que haya leído o escuchado, que le haya preocupado o que no le haya quedado claro?”

(Is there something someone told you, or something you read or heard, that worried you or wasn’t clear to you?)

(3) “¿Qué es lo que más quiere saber sobre lo que viene — sobre el tratamiento, sobre la espera, o sobre cómo está su corazón en este momento?”

(What is the thing you most want to know about what comes next — about the treatment, about the wait, or about how your heart is doing right now?)

The third question is the one that works best with patients who are stable and have been waiting for a long time. It gives them permission to name what they are actually tracking, which is often not symptoms but trajectory: the sense of whether things are moving toward something or holding in place. Holding in place is a clinical success. It does not feel like one. The nurse who names this — estable no siempre se siente como progreso, pero para el corazón, es exactamente eso — gives the patient a frame for the experience he is having.

A patient with an EF of 18% or 20% who has never been told that transplant is a conversation he is allowed to have is not a passive patient. He is a patient waiting for someone to open the door.

Practice clinical-Spanish heart failure conversations in ClinicaLingo’s free scenario library — weight gain calls, medication reconciliation, after-hours orthopnea, and more. Download the 50-phrase clinical-Spanish PDF to review the most common phrases before your next shift.

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