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INDICATIONS FOR HEART TRANSPLANT

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Heart transplantation can be utilized in patients with end-stage heart failure that is refractory to medical and surgical management.

  • Common indications for transplant:

    • Cardiomyopathy requiring IV inotropes or mechanical respiratory or circulatory support

    • Palliated congenital heart disease with heart failure requiring IV inotropes or prostaglandin E (PGE) and/or mechanical support

    • Patients with heart failure due to cardiomyopathy or congenital heart disease that leads to severe limitation of exercise/activity or growth

    • Patients with life-threatening arrhythmias untreatable with medications or an implantable defibrillator

  • Relative contraindications to transplant:

    • Severe multiorgan system disease

    • Severe pulmonary hypertension that is refractory to medical management

    • History of another medical condition that limits life expectancy in such a way that it would shorten graft survival

    • Severe psychosocial issues that may limit family's ability to care for the patient postoperatively

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TRANSPLANT EVALUATION

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In order to evaluate candidacy, a multidisciplinary team must assess the medical condition of the patient, but also the psychosocial functioning and resources of the entire family. Comorbidities must be taken into account.

  • Cardiac evaluation

    • Fully evaluate past medical and surgical cardiac history.

    • Outline cardiac condition and degree of heart failure. In patients where there is concern for specific anatomic issues or pulmonary hypertension, a cardiac catheterization may be necessary.

    • Confirm that alternative medical and surgical treatment options have been exhausted.

  • Immunologic evaluation

    • Vaccination history

    • Human leukocyte antigen (HLA) and blood typing for appropriate donor–recipient matching

  • Infectious evaluation

    • Testing for human immunodeficiency virus (HIV), hepatitis C virus (HCV), cytomegalovirus (CMV), Epstein-Barr virus (EBV)

    • Evaluation of dental health

  • General medical

    • Evaluation of brain, renal, intestinal, and hepatic systems, all of which can be affected by chronic heart failure or by underlying diagnosis

  • Psychosocial

    • Psychological evaluation of patient and family

    • Social work evaluation of patient and family support systems, financial resources, insurance

    • Formal family meeting to complete informed consent after outlining specific details of transplant and necessary lifelong changes to lifestyle

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UNOS LISTING

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Once the team makes the decision to complete listing for transplant, the patient will be assigned a wait list category through the United Network for Organ Sharing (UNOS).

  • UNOS Categories: Assigned based on clinical severity. Patients with severe disease that would otherwise be listed Status 2 can apply for an “exception” allowing them to be listed as Status 1A or 1B after review by a multicenter board.

    • Status 1A – Requiring mechanical ventilatory or circulatory (ECMO or VAD) support or congenital heart patients requiring inotropic support or with ductal dependent systemic or pulmonary blood flow who require a stent or PGE to maintain ductal patency. Patients remain hospitalized (VAD patients are exception).

    • Status 1B – Requiring inotropes but does not meet criteria for 1a or infants with restrictive or hypertrophic cardiomyopathy.

    • Status 2 – Does not meet criteria for 1A or 1B.

    • Status 7 – Temporary inactive status.

  • Transplant Waiting List: Approximately 500 children are added to the heart transplant waiting ...

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