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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.
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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
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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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 ...