When to Refer a Patient with Heart Disease

The heart may be irreversibly damaged by longlasting heart disease or viral infection. Patients with long-term heart failure, heart muscle disease, or other irreversible heart injury from coronary artery disease and multiple heart attacks that can’t be treated by any other medical or surgical means may be candidates for heart transplants.

Heart transplantation has become the treatment of choice for patients who:

• Do not have concomitant medical problems that preclude successful transplant surgery
• Do not have compliance issues that would interfere with the regimen of medications needed to prevent organ rejection

General Indications

• Irremediable terminal cardiac disease with severely compromised survival despite all other available medical and surgical therapies with survival estimates based on standard heart failure risk assessments
• Age 65 years or younger (older patients will be considered on a case-by-case basis)
• Patient selection criteria, as developed by the American Society of Transplant Physicians (ASTP) and published in the October 1998 issue of “Transplantation”, is endorsed by the Ohio Solid Organ Transplantation Consortium

Absolute Contraindications for Heart Transplant

• Significant active infection (unless related to an LVAD) or uncontrolled malignancy
• Insulin dependent diabetes when other significant, end-stage diseases are present, e.g., retinopathy, neuropathy or nephropathy
• Fixed high pulmonary vascular resistance
• Severe peripheral vascular or cerebrovascular disease
• Active peptic ulcer disease
• Chemical dependency (not known to be abstinent for at least three months) subject to psychiatric and medical consideration
• Absence of adequate external psychosocial support
• Other life-limiting illnesses
• Irreversible hepatic or renal dysfunction unless patient is being considered for multiple organ transplant