Heart-Lung Transplantation

Section: Surgery
Effective Date: March 01, 2020
Last Reviewed: January 22, 2020

Description

Heart/lung transplantation involves a coordinated triple operative procedure consisting of procurement of a donor heart-lung block, excision of the heart and lungs of the recipient, and implantation of the heart and lungs into the recipient.

Criteria

Heart/lung transplantation may be considered medically necessary for selected individuals with end-stage cardiac and pulmonary disease including, but not limited to, the following conditions:

  • Chronic obstructive pulmonary disease with heart failure; or
  • Cystic fibrosis with severe heart failure; or
  • Emphysema with severe heart failure: or
  • Eisenmenger complex with irreversible pulmonary hypertension and heart failure; or
  • Pulmonary fibrosis, non-specific, severe, with severe heart failure; or
  • Pulmonary fibrosis with uncontrollable pulmonary hypertension or heart failure: or
  • Pulmonary hypertension, irreversible, primary, with heart failure.

Potential Contraindications

Heart/lung transplantation may be considered medically necessary with ONE of the following potential contraindications (not an all-inclusive list) subject to the judgement of the transplant center:

  • AIDS when the following are noted:
    • CD4 count greater than 200 cells/mm3 for greater than six (6) months; and
    • HIV-1 RNA undetectable; and
    • On stable anti-retroviral therapy greater than three (3) months; and
    • No other complications from AIDS (e.g., opportunistic infection, including aspergillus, tuberculosis, coccidioidomycosis, resistant fungal infections, Kaposi’s sarcoma or other neoplasm); and
    • Meeting all other criteria for heart/lung transplantation.
  • Body weight outside 20% of ideal range; or
  • Cerebrovascular disease, untreated or unstable; or
  • Cancer history with a moderate or high risk of recurrence; or
  • End-stage diseases not attributed to heart or lung disease; or
  • Hypertension uncontrolled; or 
  • Infection, active, making immunosuppression unsafe; or
  • Mechanical ventilation, chronic; or
  • Musculoskeletal disease, severe, with debilitating thoracic involvement; or
  • Neuromuscular disease, progressive; or
  • Psychosocial conditions or chemical dependency affecting ability to adhere to therapy: or
  • Steroid therapy, chronic, high-dose (greater than 20mg prednisone or equivalent/day); or
  • Systemic disease that could be exacerbated by immunosuppression: or
  • Thoracotomy or sternotomy history.

Absolute Contraindications

Absolute contraindications for transplant recipients include, but are not limited to, the following:

  • AIDS (diagnosis based on CDC definition of CD4 count, 200cells/mm3); or
  • Cardiac or other ongoing insufficiencies, serious, creating an inability to tolerate transplant surgery; or
  • Conditions, serious, unlikely to be improved by transplantation as life expectancy can be finitely measured; or
  • Contraindications to immunosuppressive medications that could endanger the individual; or
  • Infections, current or recurring, not effectively treated; or
  • Malignancy, metastatic; or
  • Noncompliance, placing the organ at risk by not adhering to medical recommendations.

 

In addition to the above criteria and subject to the discretion of the transplant center, a Hepatitis C Virus (HCV) positive donor organ may be considered an acceptable organ option for an HCV negative adult recipient 18 years of age or older.

Heart/lung transplantation performed for any other condition or for individuals presenting with an absolute contraindication will be considered not medically necessary.

Heart/lung re-transplantation after a failed primary heart transplant is considered not medically necessary in individuals who do not meet criteria for heart/lung transplantation.

Procedure Codes

33930 33933 33935

Diagnosis Codes

E84.0 E84.8 I27.0 I27.20 I27.21 I27.22 I27.23
I27.24 I27.29 I27.81 I27.82 I27.83 I27.89 I27.9
I50.1 I50.20 I50.21 I50.22 I50.23 I50.30 I50.31
I50.32 I50.33 I50.40 I50.41 I50.42 I50.43 I50.810
I50.811 I50.812 I50.813 I50.814 I50.82 I50.83 I50.84
I50.89 I50.9 J43.0 J43.1 J43.2 J43.8 J43.9
J44.0 J44.1 J44.9 J84.10

Professional Statements and Societal Positions Guidelines

The International Society for Heart and Lung Transplantation-2014

The International Society for Heart and Lung Transplantation (2014) updated its consensus-based guidelines on the selection of lung transplant recipients.  These guidelines made the following statements about lung transplantation:

“Lung transplantation should be considered for adults with chronic, end-stage lung disease who meet all the following general criteria:

  • High (>50%) risk of death from lung disease within two (2) years if lung transplantation is not performed.
  • High (>80%) likelihood of surviving at least 90 days after lung transplantation.
  • High (>80%) likelihood of five(5)-year post-transplant survival from a general medical perspective provided that there is adequate graft function.”

For combined heart/lung transplant, the guidelines have stated that individuals with irreversible myocardial dysfunction or irreparable congenital defects in conjunction with intrinsic lung disease or severe pulmonary arterial hypertension are appropriate candidates for heart/lung transplantation. The guidelines also mentioned that isolated bilateral lung transplantation is associated with comparable or better outcomes in most individuals with pulmonary hypertension associated with right ventricular failure.

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