Eligibility for Heart Transplantation

We believe that heart failure patients should be optimized on standard medications, if at all possible, prior to transplantation. When patients have continued severe symptoms despite standard medications, the University of Maryland Medical Center can provide many options, including investigational medications, devices, and transplantation.

In general, we consider patients with advanced heart failure on maximal medical therapy for transplant evaluation. Patients with increasing medication requirements, frequent hospitalizations, or overall deterioration of clinical status should also be considered relatively urgently for heart transplantation.

Below is a list of criteria for inclusion in our heart transplant program, as well as a list of situations/conditions that will usually prevent a patient from receiving a transplant or even exclude them from consideration. Note that even if a patient is not a good candidate to receive a heart transplant, they may be a candidate for one of several alternative treatments, or for an experimental medical or surgical therapy available here at UMMC.

Criteria that indicate a transplant is needed

The indications for cardiac transplantation may include any of the following:

  • An estimated life expectancy of less than one year without transplant.
  • Objective evidence of advanced physical incapacity due to documented, isolated heart disease.
  • Solid agreement that previous medical therapy has been optimal and that no medical therapy or surgical procedure other than transplantation offers realistic expectation of extension of life and functional improvement.
  • Strong family support to help the patient emotionally before and after the surgery.

Conditions sometimes causing heart failure, for which a heart transplant may be recommended:

  • Inoperable coronary artery disease with congestive heart failure.
  • Cardiomyopathy (weakening of the heart muscle) of various causes.
  • Inoperable heart valve disease with congestive heart failure.
  • Severe congenital heart disease without other surgical options.
  • Life-threatening abnormal heart rhythms that do not respond to other therapy.

Criteria that could reduce eligibility for transplant

The following factors may exclude people from receiving a heart transplant:

  • Age of more than 65 years.

  • Severe irreversible pulmonary hypertension (high pressure in the lung arteries due to permanent changes in the lung blood vessels).

  • Irreversible kidney or liver dysfunction not explained by (caused by) underlying heart failure.

  • Symptomatic peripheral (legs), renal (kidney) or cerebrovascular (neck or brain) artery disease. These conditions may cause symptoms such as leg cramping with walking or at rest, foot ulcers; kidney failure or severe hypertension; or "transient ischemic attack" or stroke.

  • Severe chronic lung disease (Emphysema, asthma, chronic bronchitis).

  • Active systemic infection (Infection in the blood, lung, urine, or elsewhere, or open wound).

  • Insulin-dependent diabetes mellitus (IDDM) with evidence of damage to other organs, such as kidney, eye (retina), or nerves.

  • Cancer within the past 5 years. Exceptions may be made for some types of early skin cancer, or under other very unusual circumstances.

  • Other life-threatening diseases likely to severely limit length of life even if the transplant were successful, or to severely limit quality of life.

Under some exceptional circumstances, patients over the age of 65 or with conditions listed here that can likely be successfully managed will be considered for transplantation.

In the final analysis, in order to receive a heart transplant, the patient must believe that the potential benefits of transplantation are worth the risks.

Remember: Even if you are not a good candidate to receive a heart transplant, you may be a candidate for one of several alternative treatments, or for one of several experimental medical or surgical therapies available at UMMC.

This page was last updated: August 19, 2014

         
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