Heart Patient Selection Criteria

Indications

1. Children and adults with irremediable terminal cardiac disease with severely compromised survival despite application of other available medical and surgical therapies. Survival estimates are based on standard heart failure risk assessments
2. Any patient who is continually on the waiting list for more than two years will require verification from the transplant team that he/she is still a candidate for transplantation and continues to meet the patient selection criteria as described below
3. Age 70 years or younger (older patients will be considered on a case-by-case basis)
4. Patient selection criteria as published in the September 2006 issue of “Journal of Heart and Lung Transplantation”, Vol. 25, pp. 1024-1042, is endorsed by the Ohio Solid Organ Transplantation Consortium

Contraindications

1. Absolute:
   
   • a. Significant active infection (unless related to an LVAD) or uncontrolled malignancy
   • b. Diabetes with end organ damage other than non proliferative retinopathy or poor glycemic control despite optimal effort
   • c. Pulmonary artery hypertension and elevated PVR when PVR is > 5 Woods units or the PVR index is >6 or the TPG exceeds 16 to 20 mm Hg
   • d. Clinically severe symptomatic cerebrovascular disease which is not amendable to revascularization
   • e. Chemical dependency, including illegal narcotic usage (i.e. marijuana), not consistent with screening criteria in Substance Dependence Addendum
   • f. Absence of adequate external psychosocial support
   • g. Other life-limiting illnesses
   • h. Irreversible hepatic or renal dysfunction unless patient is being considered for multiple organ transplant
   • i. Non-compliance
2. Relative:
   • a. BMI >35 kg/m2 (or) % BMI of >140%

Relative Contraindications for Pediatric Candidates (to be reviewed on a case by case basis)

1. Prematurity (less than 36 weeks gestation)
2. Small size (less than 2 – 2.5 kg)
3. Cardiac anatomic abnormalities
   • a. Significant pulmonary artery hypoplasia
   • b. Uncorrectable pulmonary venous abnormalities
   • c. Ectopia cordis
4. Cardiac physiologic abnormalities
   • a. Elevated pulmonary vascular resistance which is irreversible with pulmonary vasodilator testing ( > 6 Wood units per meter squared)
5. Impaired and/or irreversible dysfunction or abnormality of other organ system, eg: acute renal failure, acute hepatic failure, multisystem organ failure, severe dysmorphology or genetic abnormality, profound metabolic or neuromuscular/neurologic/CNS disorder
6. Severe or significant systemic illness, for example: active infection (pneumonitis, septicemia, fever of unknown origin), HIV infection, hepatitis B/ and possibly C infection, active malignancy
7. Psychosocial pathology including alcohol or substance abuse in parents or patients, child abuse or neglect, psychiatric illness in patient (parents?), strong, and irremediable history of non compliance
8. Parental non-compliance with physician recommendations for pediatric candidates to have all age appropriate immunizations.