Radiologic and angiographic evaluations and neurologic consultation will be obtained in unclear cases. In border line cases a reassessment will be made following optimization of hemodynamics. In these cases the presence or absence of severe lung disease is evaluated based on smoking history, chest X-ray findings, and clinical history of wheezing and bronchodilator use. A history of frequent episodes of bronchitis or pneumonia will also be considered an exclusionary criterion. Smoking cessation for at least 3 months and successful completion of a smoking cessation program is required prior to listing for transplantation in stable patients.
Compliance is confirmed by blood gas testing with measurement of carboxyhemoglobin.
Acutely ill or ICU-bound patients who were smoking until the time of hospital admission may be considered if they are willing to make appropriate commitments and verbal contracts, and if the likelihood of compliance is felt to be high by the social worker and other team members. Patients with suspected abuse of ethanol or other substances will undergo careful assessment by the cardiologist, nursing coordinator, social worker and psychiatrist. Patients with documented prior abuse will be required to undergo formal evaluation by a licensed chemical dependency program. Patients with prior abuse who are currently abstinent, but in whom potential for relapse exists, will be required to participate in a licensed relapse prevention program. Compliance with abstinence will be monitored by random urine toxicology screening.