A heart transplant is a life-saving surgical procedure to replace a diseased heart
with a healthy heart from a deceased donor. Transplant is considered when an individual
has “end-stage” heart failure. This means that the condition has become so severe
that all treatments, other than heart transplant, have failed.
Coronary artery disease is the most common cause of end-stage heart failure. Other
causes are hypertensive cardiovascular disease, valvular heart disease, Primary Myocardial
Disease (PMD), and chemical agents like alcohol and certain medications.
Individuals in need of a heart transplant go through a careful selection process at
a heart transplant center. The United Network for Organ Sharing (UNOS) manages the
heart transplant waiting list. To be assigned a status level on the waiting list,
a heart transplant status justification form must be submitted. After the submission
of this form, UNOS assigns a status that reflects the medical urgency for transplant.
UNOS will not assign a status without the submission of a form.
The status levels for individuals 18 years of age or older are:
Status 1: The individual is critically ill and requires mechanical support from one of the
following:
-
•
A non-dischargeable, surgically implanted, veno-arterial extracorporeal membrane oxygenation
(VA ECMO);
-
•
A non-dischargeable, surgically implanted, non-endovascular biventricular assist device
(BiVAD); or
-
•
A mechanical circulatory support device (MCSD) with severe ventricular arrhythmias
(irregular heartbeats that originate in the lower heart chambers).
These individuals have the highest priority on the transplant list.
Status 2: The individual is on mechanical support and is dependent on at least one of the following:
-
•
A non-dischargeable, surgically implanted, non-endovascular left ventricular assist
device (LVAD);
-
•
Total artificial heart (TAH), BiVAD, right ventricular assist device (RVAD), or ventricular
assist device (VAD) for single patients;
-
•
A mechanical circulatory support device (MCSD) that is malfunctioning;
-
•
A percutaneous endovascular MCSD;
-
•
An intra-aortic balloon pump (IABP); or
-
•
The individual is experiencing recurrent or sustained ventricular tachycardia or ventricular
fibrillation occurring despite medical intervention.
Status 3: The individual has been admitted to the hospital and is receiving mechanical support
from at least one of the following:
-
•
A dischargeable LVAD and is exercising 30 days of discretionary time;
-
•
Multiple inotropes or a single high dose inotrope and has hemodynamic monitoring;
-
•
MCSD with pump thrombosis;
-
•
MCSD and right heart failure;
-
•
MCSD and has a device infection;
-
•
MCSD and has aortic insufficiency;
-
•
Veno-arterial extracorporeal membrane oxygenation (VA ECMO) after 7 days;
-
•
A non-dischargeable, surgically implanted, non-endovascular LVAD after 24 days;
-
•
A percutaneous endovascular circulatory support device after 14 days;
-
•
An IABP after 14 days; or
-
•
An MCSD and has life threatening ventricular arrhythmia after 7 days.
Status 4: The individual has at least one of the following:
-
•
Is supported by inotropes without continuous hemodynamic monitoring;
-
•
A diagnosis of congenital heart disease;
-
•
A diagnosis of ischemic heart disease with intractable angina (chest pain despite
treatment);
-
•
A diagnosis of amyloidosis, hypertrophic cardiomyopathy, or restrictive cardiomyopathy;
or
-
•
Is a re-transplant (a second or subsequent transplantation) with International Society
of Heart and Lung Transplantation (ISHLT) coronary allograft vasculopathy (CAV) grade
2-3, or New York Heart Association (NYHA) Class III-IV heart failure symptoms.
Status 5: The individual needs a dual heart transplant (heart-lung, heart-liver, heart-kidney)
and does not meet criteria for status levels 1 to 4.
Status 6: Individuals classified as adult status level 6 do not meet the criteria for statuses
1-5 but are suitable for transplant.
NOTE: Adult status levels 1-4 are the most severe and are considered CAL-level conditions.
Although severe, status levels 5 and 6 are not considered CAL-level conditions.
|