Heart-Lung Patient Selection Criteria

General Indications

In the past, it has been shown that pulmonary transplant as a desperate attempt for deathbed rescue has been doomed to failure. Only with rigid selection criteria has clinical success been realized.

All patients considered for heart-lung transplantation shall be:

less than 60 years of age
free from other major organ failure
expected to have a survival time of not more than 12 to 24 months without a transplant

Specific Indications

Patients with the following disease processes are considered as candidates for transplantation. They should be functionally limited, but not totally disabled. There is a "transplant window" during which the patient has a gradual decline from the natural history of his/her disease, but has not deteriorated so much that he/she is no longer a viable transplant candidate.

Patients to be considered include, but are not limited to, those with the following diagnoses:

Eisenmenger's syndrome
Primary pulmonary hypertension
Cardiomyopathy with pulmonary hypertension
Emphysema
Alpha-1 antitrypsin deficiency
Pulmonary fibrosis
Cystic fibrosis
Bronchiectasis
Bronchopulmonary dysplasia
Post-transplant obliterative bronchiolitis
Pulmonary disease in young infant for technical surgical issues (typically due to the airway size)

Contraindications

Absolute:
- a. Significant systemic or multi-system disease
- b. Active or systemic infection limiting survival
- c. Significant hepatic disease
- d. Significant renal disease
- e. Current cigarette smoking (minimum 6 months abstinence and a commitment to continue non-smoking post-transplant)
- f. Psychiatric illness
Relative:
- a. Previous cardiac or thoracic surgery
- b. Diabetes mellitus
- c. Peptic ulcer disease
- d. Chemical dependency, including illegal narcotic usage (i.e. marijuana), not consistent with screening criteria in Substance Dependence Addendum
- e. Corticosteroid therapy (>20 mg/day)
- f. History of cancer
- g. Cachexia (<17 BMI) or obesity (>30 BMI)
- h. Non-compliance