Who is the Candidate? The Heart Transplant Evaluation Process

The evaluation for heart transplantation is a comprehensive endeavor requiring multidisciplinary collaboration. The goal of a heart transplant evaluation is to determine if (1) the patient’s cardiac status is limited enough, despite optimal medical therapy, to benefit from heart transplantation; (2) the patient does not have comorbidities that would preclude heart transplantation; and (3) the patient demonstrates compliance and possesses adequate social support. The most common indications for heart transplant are highly symptomatic heart failure with reduced ejection fraction, uncontrolled ventricular arrhythmias, or intractable angina. Extracardiac contraindications require specific considerations regarding whether they will (1) confer mortality risk that will negate the expected improvement in survival after transplantation; (2) affect post-transplant quality of life and hamper rehabilitation efforts; and (3) progress with immunosuppression. With careful and appropriate selection, heart transplant recipients are best positioned to experience the improved quality of life and survival expected after transplantation.