Indications for heart transplantation

Abstract

Heart transplantation provides a solution to end-stage heart failure when all other therapeutic options have failed. A successful outcome can only be expected in a properly indicated patient; the decision requires a comprehensive consideration of a variety of medical and social factors. The algorithm of examination includes the assessment of: 1. current status and its reversibility; 2. likely prognosis of the disease while receiving conservative therapy; 3. associated conditions which might represent a contraindication to transplantation; 4. other therapeutic options in heart failure, which might serve as an alternative or a "bridge" to heart transplantation; 5. patient compliance; and 6. social aspects. Although the ultimate decision is the responsibility of a specialist center, initial screening is usually performed by the practicing cardiologist-internist; it is up to them whether and why they will refer the patient to the respective heart center.