TN 5 (07-11)
DI 23022.560 Heart Transplant Wait List 1A/1B
HEART TRANSPLANT WAIT LIST- 1A/1B
Cardiac Transplant; Transplant-Heart
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 VAD (ventricular assist device) 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 (ventricular assist device) or low doses of continuous intravenous medications. Individuals classified as Status 1B have the second highest priority on the heart transplant, wait list.
|DIAGNOSTIC TESTING, PHYSICAL FINDINGS, AND ICD-9-CM CODING |
Medical report of physical findings including a statement that the person has been placed on the heart transplant waiting list, chest x-ray, electrocardiogram, echocardiogram, cardiac catherization, and cardiac magnetic resonance imaging.
ONSET AND PROGRESSION
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.
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.
SUGGESTED PROGRAMMATIC ASSESSMENT*
Suggested MER for Evaluation:
Suggested MER for Evaluation: Clinical description of findings, operative reports, cardiology consultation reports, x-ray showing heart failure, electrocardiogram showing indications of the need for mechanical assist devices such as ICDs or VADs
Suggested Listings for Evaluation:
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* Adjudicators may, at their discretion, use the Medical Evidence of Record or Listings suggested to evaluate the claim. However, the decision to allow or deny the claim rests with the adjudicator.