The waiting list can be a confusing concept for transplant candidates awaiting a heart. A match between a candidate and donor is based on matching blood type and body size. Individuals with blood type O may only receive a heart from a donor with blood type O, however a donor with blood type O may donate to any blood group candidate. Sizing of a donor is based on weight, with some consideration of height.
Candidates may be listed at any of several statuses when they are activated on the waiting list. A Status 2 designation indicates that candidates are stable and not on any special life support medications or equipment. To qualify as a Status 1B, candidates must be receiving a continuous intravenous infusion of a medication that supports heart function or have a mechanical assist device in place greater than 30 days from reactivation. Finally, to qualify for Status 1A , candidates must be patients in the hospital and require some form of life support. Candidates in this category are the most ill and are not considered medically stable. A designation of Status 7 means a candidate is temporarily inactive and not eligible to receive a heart at this time. This category may be utilized for an individual who is ill with an infection or occasionally someone who is considered too well to transplant at the present time. Individuals who are status 7’s do not continue to accumulate waiting time but do not lose any time that they have accrued.
Once a potential donor is matched to potential recipients based on blood type and body size the organ is offered to candidates in the Status 1A category first, then Status 1B and Status 2 last. If a donor matches more than one candidate in the same status category the organ is offered to the individual with the longest time in that status category first. Once candidates are listed for transplant they may change categories depending on their medical condition. It is imperative that individuals that are listed for a heart transplant are followed regularly by the transplant cardiologist to monitor their condition. In addition all listed candidates must undergo repeat right heart catheterizations every 3-6 months while they are active on the waiting list. This is important to monitor the pulmonary pressures in the event they go too high and require medication to reverse the trend. Candidates with pulmonary pressures that are too high may become ineligible for a heart transplant alone and a heart/lung transplant may be required.
- Debra Carter, M.S., C.R.N.P., C.C.T.C., Heart Transplant Coordinator
