Referral Process

Referral Form

Considerations When Referring for Heart Transplant

Transplant Eligibility Criteria:

• End-stage cardiac disease as a result of poor cardiac function or uncontrollable ventricular arrhythmias that can no longer be treated with medications and/or other surgeries.
• Absence of serious systemic illness or other medical conditions that may affect immediate or long-term survival.
• Age 68 or less with a high likelihood of becoming healthy, productive, functional individuals with a life expectancy of at least 5-10 years.
• Full understanding of transplant procedure, it's limitations and long-term compliance to follow-up requirements.
• Strong social support network, especially family.
• Free from active drug, nicotine or alcohol abuse.
• Weight less than 135% of IBW

Indications for Heart Transplant:

• Poor 12-24 month prognosis without heart transplantation (based on combination of variables).
• LV dysfunction without CAD
LVEF < 20-25%, LV diameter > 7 cm, poor right heart pressures (CVP > 12, PCWP > 18, PAS > 50, CI < 2.2) on medical therapy, poor exercise tolerance (VO2 max < 14 ml/kg/min), advanced symptoms.
• LV dysfunction secondary to CAD (not amenable to further revascularization) – more liberal criteria than above based on individual assessment.
• Other – hypertrophic cardiomyopathy, congenital heart disease, valvular heart disease, etc.
• NYHA Class III-IV or intractable severe angina that is not amenable to other therapies.
• Refractory ventricular dysrhythmias.

Absolute Contraindications for Heart Transplant:
Factors which place individual at highest risk for poor outcome, poor quality of life or increased mortality

• Intrinsic renal dysfunction – Renal ultrasound will be obtained if creatinine clearance < 50 ml/min to assess for structural abnormalities. Note: heart-kidney transplantation may be considered in carefully selected patients.
• Irreversible liver disease.
• Pulmonary dysfunction (COPD) which is severe.
• Recent pulmonary embolus.
• Complicated diabetes mellitus (poor control, retinopathy, neuropathy, nephropathy).
• Active severe infection.
• Advanced peripheral vascular disease/diffuse atherosclerosis.
• CNS – dementia, active seizure disorder, stroke with poor rehabilitation.
• Cardiac amyloid.
• Patient > 68 years will not be evaluated for heart transplant at Emory University Hospital.
• Active substance abuse – nicotine, ETOH, illicit drugs.
• Severe psychiatric dysfunction.
• Malignancy with high risk of recurrence.
• Non-compliance with medical regimen.

Relative Contraindications for Heart Transplant:
Factors which place individual at higher risk for poor outcome, poor quality of life or increased mortality

• Uncontrolled hypertension.
• If age > 60, renal function and relative contraindications evaluated carefully.
• Obesity (> 135% IBW).
• Active systemic illness that would limit long-term survival.
• Inadequate transportation to and from medical appointments.
• Inadequate financial resources to support post transplant needs.
• Inadequate support system including family and friends.

Transplant Center

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