HEART TRANSPLANT WAIT LIST 1A/1B
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ALTERNATE NAMES |
Cardiac Transplant; Transplant-Heart
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DESCRIPTION
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Heart Transplant is a life-saving surgical procedure to replace a person’s diseased
heart with a healthy heart from a deceased person (donor). Heart transplantation is
considered when there are no other medical or surgical options available to the patient.
Ninety percent of heart transplantations are done on persons who have “end-stage”
heart failure. End-stage means that the condition has become so severe that all treatments,
other than heart transplant, have failed. Donor hearts are in short supply, so individuals
who need a heart transplant go through a careful selection process at a heart transplant
center. Persons who are eligible for a heart transplant are placed on a waiting list.
The United Network for Organ Sharing (UNOS) manages the heart transplant waiting list.
In order to determine the order of priority for receipt of a donor heart, individuals
are classified by degrees of severity for a donor heart, blood type, body weight,
and geographic location.
Individuals classified as Status 1A have the highest priority on the heart transplant
waiting list. Status 1A are individuals who must stay in the hospital as in-patients
and require high doses of intravenous drugs, require a ventricular assist device (VAD)
for survival, are dependent on a ventilator or have a life expectancy of a week or
less without a transplant.
Individuals classified as Status 1B are generally not required to stay in the hospital
as in-patients. These individuals may require a VAD or low doses of continuous intravenous
medications. Individuals classified as Status 1B have the second highest priority
on the heart transplant, wait list.
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DIAGNOSTIC TESTING, PHYSICAL FINDINGS, AND
ICD-9-CM/ICD-10-CM
CODING |
Diagnostic testing: Medical report of physical findings including:
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A statement that the person has been placed on the heart transplant waiting list;
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Cardiac catherization; and
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Cardiac magnetic resonance imaging (MRI).
Physical findings: The symptoms of end-stage heart failure include:
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Dyspnea (shortness of breath);
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Chronic cough or wheezing;
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Nausea or lack of appetite;
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Confusion or impaired thinking.
ICD-9:
428.0
ICD-10: Z94.1
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TREATMENT
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Persons on the waiting list for a donor heart receive ongoing treatment for heart
failure and other medical conditions such as irregular heartbeats (arrhythmias). These
conditions can cause sudden cardiac death. Depending on the severity of their condition,
some persons receive mechanical assist devices such as implantable cardioverter defibrillators
(ICDs) to control the irregular heartbeat or a VAD to help the heart pump blood before
the actual heart transplant surgery. Heart transplant surgery carries many risks including
rejection of the donor heart. Signs of rejection include shortness of breath, fever,
fatigue, weight gain, and reduced amounts of urine resulting from kidney problems.
Other complications include medication reaction, infection, and cancer. Cardiac Allograft
Vasculopathy (CAV), a blood vessel disease, may develop.
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PROGRESSION
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There is currently a shortage of donor hearts available for the approximately 3,000
people on the waiting list for a heart transplant in the United States. Organs are
matched for blood type and size of donor and recipient. A person can be taken off
the waiting list if a serious medical event such as a stroke, infection, or kidney
failure develops. Time spent on the heart transplant waiting list is a key factor
in determining who receives a donor heart. Another factor that is taken into consideration
is the urgency of need. Some individuals die while waiting for a suitable donor heart
due to the current shortage of available donor hearts.
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SUGGESTED PROGRAMMATIC
ASSESSMENT* |
Suggested MER for Evaluation:
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Clinical history and examination that describes the diagnostic features of the impairment;
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Cardiology consultation reports;
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X-ray showing heart failure; and
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Transthoracic echocardiogram showing indications of the need for mechanical assist
devices such as ICDs or VADs.
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Suggested Listings for Evaluation:
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DETERMINATION |
LISTING
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REMARKS |
Meets |
4.02 |
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104.02 A, B, or C |
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Equals |
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* Adjudicators may, at their discretion, use the Medical Evidence of Record or the
listings suggested to evaluate the claim. However, the decision to allow or deny the
claim rests with the adjudicator.
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