Exclusionary criteria are listed in the policies and protocols document in the Appendix. In general, patients should be free of systemic conditions which independently limit the patient's long term survival. In addition, conditions which will be significantly exacerbated by transplant should not be present. We attempt to view a weighted sum of any non-cardiac illnesses in the context of the patient's age, severity of cardiac disease, and psychosocial evaluation in order to determine the overall risk benefit ratio for transplantation. Details of our approach to the evaluation of some of these issues are explicitly outlined in Appendix A. Implementation of Selection Criteria Patients referred for consideration for cardiac transplantation undergo an initial history and physical examination by the transplant cardiologist.
Initial evaluation focuses on two factors.
First, the cardiac condition is evaluated and determined if it is of sufficient severity to warrant transplantation. Second, the adequacy of current medical therapy is assessed. Subsequently, medical regimens are optimized, frequently with the guidance of invasive hemodynamic monitoring. If, after this initial evaluation, transplantation is felt to be the only alternative to provide a reasonable chance of long term survival and quality of life, a full transplant evaluation is performed. Noninvasive and laboratory testing is performed to assess pulmonary, renal, hepatic, cerebrovascular, and peripheral vascular disease.