Heart transplantation consists of replacing a diseased heart with a healthy donor heart. It is used for individuals with refractory end-stage cardiac disease.
Adult Individuals –
Heart transplantation may be considered medically necessary for selected adults with end-stage heart failure when individual selection criteria are met:
Probable Indications for Heart Transplantation
Inadequate Indications for Heart Transplantation
Unless other factors as listed above are present, the following conditions are considered not medically necessary:
Heart transplantation for all other adult conditions is considered not medically necessary.
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.
Pediatric Individuals – Accepted Indications for Heart Transplantation
Heart transplantation may be considered medically necessary for selected children with end-stage heart failure when individual selection criteria are met:
Heart transplantation for all other pediatric conditions is considered not medically necessary.
The following conditions represent potential contraindications to heart transplantation subject to the judgement of the transplant center:
Conditions determined to be a contraindication to heart transplantation are considered not medically necessary.
Heart re-transplantation after a failed primary heart transplant may be considered medically necessary in individuals who meet criteria for heart transplantation.
Heart re-transplantation after a failed primary heart transplant is considered not medically necessary in individuals who do not meet criteria for heart transplantation.
American College of Cardiology Foundation and American Heart Association-2017
Guidelines from the American College of Cardiology Foundation and American Heart Association were updated in 2017.Evaluation for heart transplantation was recommended for [individuals] in whom heart failure is assessed as refractory based on New York Heart Association functional class III or IV (stage D) for heart failure after previous guideline-directed medical therapy, use of devices such as an implantable cardioverter defibrillator or a cardiac resynchronization therapy device, or surgical management.
American Heart Association-2007
TheAmerican Heart Association(2007) indicated that, based on level B (nonrandomized studies) or level C (consensus opinion of experts) evidence, heart transplantation is indicated for pediatric [individuals] as therapy for the following indications:
European Society of Cardiology-2016
The European Society of Cardiology (2016) guidelines on the diagnosis and treatment of acute and chronic heart failure recommended considering heart transplantation for [individuals] with end-stage heart failure with severe symptoms, poor prognosis, and no alternative treatment options.Active infection, severe peripheral arterial or cerebrovascular ischemia, pharmacologically irreversible pulmonary hypertension, cancer, renal insufficiency, systemic disease with multi-organ involvement, pre-transplant body mass index greater than 35 kg/m2, current alcohol or drug abuse, and insufficient social support to achieve compliant care in the outpatient setting were considered relative contraindications for heart transplantation.