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Tobacco Abstinence Criteria
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ADDENDUM B TO PATIENT SELECTION CRITERIA

Screening Criteria for Heart and Lung Patients Presenting with History of Tobacco Use

Heart and lung transplant candidates must be free of nicotine and tobacco use, including chewing tobacco, for six months prior to an initial listing.

1)      This six month time period may be reduced for heart transplant candidates if:

a.       The patient has not previously been made inactive on the waiting list or de-listed from the waiting list because of a positive cotinine urine test; and

b.      The patient is medically urgent and unlikely to survive the required six month period prior to listing, as determined by either one of the following:

i.      The patient meets UNOS medical definition of Status 1A; or

ii.      The patient meets the UNOS medical definition of Status 1B and is unstable as indicated by being hospitalized on inotropes and unable to have a ventricular assist device placement.

c.       Patients with less than six months of being free of nicotine and tobacco use under the medically urgent exception noted above will be reviewed by the Heart Patient Selection Committee comprised of, at a minimum, the Director of Health, one experience transplant physician from each organ transplant program who actively participates in transplant services, an ethicist or bioethicist, and a lay representative who may be an attorney.  The candidate shall sign a contract pledging not to use nicotine or tobacco in the future, must attend smoking cessation classes as prescribed by each transplant center and agree to unlimited, random cotinine urine tests both while awaiting, as well as after transplantation.  The Heart Patient Selection Committee shall determine whether the patient is appropriate to list for transplantation.

2)      This six month time period may be reduced for lung transplant candidates on a case-by-case basis.

a.       Patients with less than six months of being free of nicotine and tobacco use under the medically urgent exception noted above will be reviewed by the Lung Patient Selection Committee comprised of, at a minimum, the Director of Health, one experience transplant physician from each organ transplant program who actively participates in transplant services, an ethicist or bioethicist, and a lay representative who may be an attorney.  The candidate shall sign a contract pledging not to use nicotine or tobacco in the future, must attend smoking cessation classes as prescribed by each transplant center and agree to unlimited, random cotinine urine tests both while awaiting, as well as after transplantation.  The Lung Patient Selection Committee shall determine whether the patient is appropriate to list for transplantation.

3)      While on the waiting list, unannounced nicotine screens by cotinine urine test will be performed at least every four to six weeks.

4)      If the patient has a positive cotinine urine test during the time he or she is awaiting transplant, the transplant center will either make the patient inactive on the waiting list or de-list the patient from the waiting list.  Before being re-activated or re-listed, the patient:

a.       Must re-establish a six month period of abstinence; and

b.      Attend smoking cessation classes as prescribed by each transplant center’s treatment team.

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