Placement on the heart transplant waiting list requires meeting stringent, nationally standardized criteria (UNOS/OPTN in the U.S.). Five core pillars:
- End-stage heart failure – Refractory to optimal medical, device, and surgical therapy (GDMT, CRT, LVAD). Etiologies: ischemic cardiomyopathy, non-ischemic dilated cardiomyopathy, valvular heart disease, congenital heart disease, restrictive/infiltrative cardiomyopathies.
- Life expectancy without transplant ≤1 year – Quantified by objective metrics: peak VO₂ <14 mL/kg/min (or <16 with beta-blocker), LVEF ≤20%, recurrent hospitalizations, renal/hepatic dysfunction from low output.
- Functional capacity for post-transplant survival – Ability to perform ADLs, participate in rehabilitation, tolerate lifelong immunosuppression. Frailty, severe sarcopenia, or fixed pulmonary hypertension (PVR >5 Wood units unresponsive to vasodilators) may be contraindications.
- Psychosocial stability & support system – Demonstrated adherence history; reliable caregiver(s); stable housing, transportation, insurance; no active substance use; cognitive capacity for complex regimen.
- Psychiatric evaluation – Screens for untreated major depression, psychosis, personality disorders, or cognitive impairment that could jeopardize adherence or informed consent.
Additional: ABO-compatible donor availability, sensitization (cPRA), and size match influence wait time. Criteria may vary slightly by transplant center; all follow OPTN policy.
