Potential contraindications for solid organ transplant subject to the judgment of the transplant center include the following:
- Known current malignancy, including metastatic cancer; or
- Recent malignancy with a high risk of recurrence; or
- Untreated systemic infection making immunosuppression unsafe, including chronic infection; or
- Other irreversible end-stage diseases not attributed to heart or lung disease; or
- History of cancer with a moderate risk of recurrence; or
- Systemic disease that could be exacerbated by immunosuppression; or
- Psychosocial conditions or chemical dependency affecting the ability to adhere to therapy.
Policy-specific potential contraindications include:
- Pulmonary hypertension that is fixed as evidenced by pulmonary vascular resistance greater than six (6) Wood units, or transpulmonary gradient greater than or equal to16 mm/Hg despite treatment; or
- Severe pulmonary disease, despite optimal medical therapy, not expected to improve with heart transplantation
Pediatric individuals must meet the United Network for Organ Sharing (UNOS) guidelines for status one A or one B (1A, 1B), or status two (2). Adult individuals must meet the United Network for Organ Sharing (UNOS) guidelines for status One (1), Two (2), Three (3) or Four (4).
Specific criteria for prioritizing donor thoracic organs for transplant are provided by the Organ Procurement and Transplantation Network (OPTN) and implemented through a contract with UNOS. Donor thoracic organs are prioritized by UNOS on the basis of recipient medical urgency, distance from donor hospital, and pediatric status. Individuals who are most severely ill (Adults status 1 or Pediatrics status 1A) are given the highest priority. The following factors are considered in assessing the severity of illness: reliance on continuous mechanical ventilation, infusion of intravenous inotropes, and/or dependency on mechanical circulatory support (i.e., total artificial heart, intra-aortic balloon pump, extracorporeal membrane oxygenator, ventricular assist device).
Additional criteria, which are considered in pediatric individuals, include diagnosis of an OPTN-approved congenital heart disease diagnosis, presence of ductal dependent pulmonary or systemic circulation, and diagnosis of hypertrophic or restrictive cardiomyopathy while less than one (1-) year-old. Of note, pediatric heart transplant candidates who remain on the waiting list at the time of their 18th birthday without receiving a transplant continue to qualify for medical urgency status based on the pediatric criteria.