When to Consider a Heart Transplant

When a person with heart disease has tried all medical therapies and no other surgical procedures will correct the underlying disease, they have entered what is called end-stage heart disease. At this point, a heart transplant becomes an important treatment option. If you have advanced heart failure, and are taking the maximum amount of medication therapy that can be prescribed, you may be a candidate for a heart transplant.

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Heart transplant candidates must be in otherwise good health and free of other serious medical illness. You should also be psychologically stable and be willing to comply completely with the rigorous post-transplant medical regimens that will be needed.

While the requirements for transplant may differ slightly at various centers, certain risk factors are associated with higher morbidity and decreased compliance. There are also well-described exclusion criteria that have been shown to decrease short and long-term survival. If you have any of the following conditions, you may not be a good candidate for a heart transplant:

  • Irreversible pulmonary hypertension, defined as a pulmonary vascular resistance index higher then 6-8 Wood units/m2
  • Irreversible pulmonary parenchymal disease
  • Irreversible renal dysfunction, defined as creatinine greater then 25mg/dl and a creatinine clearance less than 50 ml/min., unless combined with kidney transplantation
  • Primary hepatic dysfunction, such as cirrhosis or hepatic dysfunction with resultant coagulopathy
  • Significant peripheral and cerebrovascular disease
  • Insulin dependent diabetes mellitus with end-organ damage or high insulin requirements without end-organ damage
  • Co-existing neoplasm
  • Acute pulmonary embolism or infarction
  • Myocardial infiltrate or inflammatory disease, such as sarcoidosis and amyloidosis

Consult your physician to determine whether a heart transplant would be the right choice for you. The next step would be to begin the transplantation evaluation process.




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