Heart Transplant Patient Selection Criteria

Indications

Maximal VO2 < 10 ml/kg/min with achievement of anaerobic metabolism
Severe ischemia consistently limiting routine activity not amenable to revascularization
Recurrent symptomatic ventricular arrhythmia refractory to all accepted therapeutic modalities

Maximal VO2 < 14 ml/kg/min and major limitation of the patient’s daily activities.
Recurrent unstable angina not amenable to revascularization
Unstable fluid balance/renal function not due to patient noncompliance with regimen of weight monitoring, flexible use of diuretics and salt restriction
Ross classification III-IV
NYHA Class III-IV symptoms on optimal medical therapy and prognosis for 1 year survival less than 75%
Heterotopic heart transplant
End-stage heart disease not amenable to other medical or surgical therapy with irreversible pulmonary hypertension
NYHA Class III-IV symptoms on optimal medical therapy and prognosis for 1 year survival less than 75%
No underlying pulmonary disease

Absolute contraindications for adults and children include, but may not be limited to:

Major systemic disease
Age inappropriateness (70 years of age)
Cancer in the last 5 years except localized skin (not melanoma) or stage I breast or prostate
Active smoker (less than 6 months since quitting)
Active substance abuse
HIV
Severe local or systemic infection
Severe neurologic deficits
Major psychiatric illness or active substance abuse that cannot be managed sufficiently to allow post-transplant care and safety

Relative contraindications for adults and children include, but may not be limited to:

Severe pulmonary hypertension with PAS > 60 mm Hg, TPG > 15 mm Hg, PVR > 3.5 Wood Units irreversible with milrinone
Pulmonary dysfunction with FVC and FEV1 < 40% predicted especially with intrinsic lung disease on imaging
Acute pulmonary thromboembolism
Morbid obesity (>140% Ideal body weight. For males, 106 lbs. for first 5 ft of height then 6 lbs. for each additional inch. For women, 100 lbs. for first 5 feet of height then 5 lbs. for each additional inch)
Irreversible hepatic dysfunction with bilirubin > 2.5 mg/dL and/or transaminases > 2 x normal, or cirrhosis on biopsy
Irreversible renal dysfunction with creatinine clearance < 40-50 mL/min or ERPF < 200 mL/min (Effective Renal Plasma Flow)
Documented severe peripheral or cerebrovascular disease
Coexisting neoplasm or history of neoplasm other than skin within 5 years
Insulin-requiring diabetes mellitus with end-organ damage
Active peptic ulcer disease
Current or recent diverticulitis
Cachexia
Inability to make a strong commitment to transplantation
Absence of adequate external psychosocial supports for either short-term or long-term basis