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Updated: Nov 27, 2025
Implantation of Total Artificial Heart in Congenital Heart Disease
Published on: July 18, 2014
Heart transplantation candidacy
Jefferson L Vieira1, Mandeep R Mehra
1Heart and Vascular Center, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
Insights
Evaluating heart transplant candidates is becoming more complex due to changing patient profiles and new policies. Recent advances focus on improving eligibility assessments for advanced therapies like heart transplantation.
Area of Science:
- Cardiology
- Transplantation Medicine
- Medical Ethics
Background:
- Heart transplantation eligibility criteria have evolved.
- Candidate profiles have become more complex over time.
- Advanced therapies like heart transplantation require careful candidate selection.
Purpose of the Study:
- To review recent advancements in the evaluation process for heart transplantation eligibility.
- To discuss the changing landscape of heart transplant candidate characteristics.
- To summarize updates in heart transplantation allocation policies.
Main Methods:
- Review of recent literature on heart transplantation evaluation.
- Analysis of changes in heart transplantation allocation policies in the USA.
- Examination of listing practices and candidate acceptance criteria.
Main Results:
- Heart transplantation allocation policies have been updated to reduce waitlist mortality and ensure equitable organ distribution.
- Patients with chronic infectious diseases and malignancies are increasingly considered for heart transplantation.
- Listing practices vary, with higher-volume centers showing more willingness to accept high-risk candidates.
Conclusions:
- The decision to list high-risk candidates requires a blend of quantitative data, qualitative analysis, and clinical judgment.
- The organ donor shortage presents ethical challenges in heart transplantation candidate selection.
- Future guidelines should address fair organ allocation and improved post-transplantation outcomes.
Purpose Of Review:
Timely referral of eligible candidates for consideration of advanced therapies, such as a heart transplantation or mechanical circulatory support is essential. The characteristics of heart transplantation candidates have changed significantly over the years, leading to a more complex evaluation process. The present review summarizes recent advances in the evaluation process for heart transplantation eligibility.
Recent Findings:
The heart transplantation allocation policy was recently reviewed in the USA in an effort to reduce waitlist mortality and to ensure fair geographic allocation of organs to the sickest patients. Moreover, patients with chronic infectious diseases, as well as malignancies, are being currently considered acceptable candidates for transplantation. Listing practices for heart transplantation vary between programmes, with a greater willingness to consider high-risk candidates at higher-volume centres.
Summary:
The ultimate decision to place high-risk candidates on the heart transplantation waitlist should be based on a combination of quantitative and qualitative data analysis informed by clinical judgement, and the chronic shortage of organ donors makes this process an important ethical concern for any society. Future guidelines should discuss approaches to achieve fair organ allocation while preserving improved outcomes after transplantation.
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