Identification and management of potential heart transplant recipients

Transplantation should be performed to improve the quality and duration of life in patients with end-stage cardiac disease. Symptoms, left ventricular ejection fraction, previous and present medications, and an exercise tolerance test serve as basic screening information to identify potential transplant candidates. Patients need to have a psychological, financial, and behavioral profile that will allow them to withstand the rigors of the entire transplantation process, and have no other medical problems that would jeopardize their survival following transplant surgery. Maintenance of the patient's status while awaiting a cardiac donor begins with patient education and a search into the causes of underlying ventricular dysfunction. Medications subsequently used include diuretic agents, vasodilators, digitalis, anticoagulants, antiarrhythmics, and possibly beta-blocker therapy. When standard measures fail, potent inotropes and even mechanical assist devices are sometimes necessary. Future donor heart allocations will require more rigid criteria for the selection of cardiac transplant candidates.