Page 10 - Heart Transplant Guidelines
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Heart Function Service: Heart Transplant Guidelines

               Pre-Transplant Nutrition Assessment
                   •  Assess patient’s nutritional status.
                   •  Monitor both early and long-term nutritional intake and status to promote healing,
                       manage weight, and meet the body’s requirements.
                   •  Recommend dietary intervention to maximize pre-transplant nutritional status.
                   •  Educate the family regarding potential nutritional risks, negative outcomes associated
                       with poor nutrition, and interventions that support long-term transplant success and
                       optimal health.


               Pre-Transplant Financial Assessment

                   •  Completion of a financial screening.
                   •  Review medical, as well as current pharmacy benefits.
                   •  Discuss the importance of maintaining active coverage and advising on coverage
                       changes.


               Indications and Contraindications to Transplant & Re-transplant

                                                    Primary Cardiac Transplant
                 Indications                 Relative Contraindications           Absolute Contraindications
                 End stage heart failure     Neuro-devastation injuries           Active malignancy
                 Intractable arrhythmias     Severe psychiatric disorder          Severe hypoplastic PAs
                 Unrepairable CHD            Human immunodeficiency virus         Severe pulmonary vein stenosis
                 Unresectable cardiac tumor   Pulmonary hypoplasia                Severe elevated PVR
                                             Non adherence*                       Refusal of blood products
                                             Inadequate social or financial support*
                                             BMI > 35
                                *Non- adherence and inadequate social/financial support are absolute contraindications
                                          after attempts to mitigate risk have been exhausted


               Patients considered for re-transplantation will undergo a complete re-evaluation to establish that they
               are a candidate. A Recipient Evaluation will be completed and the patient will be presented to the
               Cardiac Transplant Multidisciplinary Team for consideration. If the patient is felt to be a candidate, all
               guidelines and procedures as for an initial listing and transplant will be initiated and followed.

                                                    Cardiac Re-Transplantation
                 Indications                Relative Contraindications            Absolute Contraindications
                 End-stage graft failure which  Neuro-devastation injuries        Active Malignancy
                 is not recoverable by further
                 medical or surgical therapy.
                 Limited life expectancy,   Severe psychiatric disorder           Inadequate vascular access
                 usually one year or less
                                            Human immunodeficiency virus          Refusal of blood products







               Updated May 17, 2018                                                                        10
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