Patient Selection and Indications for Heart Transplantation

Heart transplantation can substantially improve survival and quality of life for patients with end-stage heart failure. Limited donor availability and the growing prevalence of heart failure has led to a widening gap between those in need of heart transplantation and those who will receive a transplant. Therefore, heart transplant candidacy is more restrictive than candidacy for other organs. Fortunately, therapies for heart failure are improving, which may prevent or delay the need for transplant. Additionally, improvements in chronic left ventricular assist device (LVAD) technology have resulted in better capability to bridge patients to transplants and to improved survival for patients who are not transplant candidates. Heart allocation policies based on severity of illness have made it uncommon for the patient without continuous inotropic therapy or LVAD to be called in from home for a transplant. Thus, an understanding of the priority system is important in not only managing the patient's illness, but also in managing his/her expectations. This chapter reviews heart transplant candidacy, including expected outcomes, indications, and contraindications.