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Listing criteria for heart transplantation in the Netherlands
N de Jonge1, K Damman2, F Z Ramjankhan3
1Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands. n.dejonge@umcutrecht.nl.
Insights
Updated heart transplant listing criteria prioritize patients benefiting most from scarce donor organs. This ensures optimal life expectancy and quality of life for end-stage heart disease patients.
Area of Science:
- Cardiology
- Transplantation Medicine
Background:
- Donor heart shortage necessitates careful patient selection for heart transplantation.
- End-stage heart disease management requires advanced therapeutic strategies.
Purpose of the Study:
- To present updated listing criteria for heart transplantation in the Netherlands.
- To guide the selection of patients who will gain the greatest benefit from heart transplantation.
Main Methods:
- Review of current practices and patient outcomes.
- Assessment of end-stage heart disease severity through cardiopulmonary stress testing, prognostic stratification, and invasive hemodynamic measurements.
- Consideration of optimal medical therapy, including implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy with defibrillation (CRT-D).
Main Results:
- Updated criteria focus on maximizing life expectancy and quality of life from scarce donor hearts.
- Timely referral to tertiary centers is crucial for optimal patient outcomes.
- Chronic mechanical circulatory support is increasingly utilized as a bridge to transplantation and for advanced heart failure.
Conclusions:
- Revised listing criteria aim to optimize the allocation of donor hearts.
- Mechanical circulatory support offers a vital alternative and bridge for patients awaiting heart transplantation.
- Integrated management of advanced heart failure involves transplantation and mechanical support.
Abstract:
The updated listing criteria for heart transplantation are presented on behalf of the three heart transplant centres in the Netherlands. Given the shortage of donor hearts, selection of those patients who may expect to have the greatest benefit from a scarce societal resource in terms of life expectancy and quality of life is inevitable. The indication for heart transplantation includes end-stage heart disease not remediable by more conservative measures, accompanied by severe physical limitation while on optimal medical therapy, including ICD/CRT‑D. Assessment of this condition requires cardiopulmonary stress testing, prognostic stratification and invasive haemodynamic measurements. Timely referral to a tertiary centre is essential for an optimal outcome. Chronic mechanical circulatory support is being used more and more as an alternative to heart transplantation and to bridge the progressively longer waiting time for heart transplantation and, thus, has become an important treatment option for patients with advanced heart failure.
