Heart transplantation indications

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Heart transplantation Microchapters


Patient Information


Historical Perspective




Epidemiology and Demographics

Risk Factors


Complications and Prognosis





Criteria for Cardiac Transplantation

Equitable Distribution of Donor Hearts to those Awaiting Transplantation and the Process of Being Listed for a Transplant


Medical Therapy



Electrocardiogram and Pacing After Cardiac Transplantation

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Editor(s)-in-Chief: C. Michael Gibson, M.S., M.D.; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [1]Ifrah Fatima, M.B.B.S[2]


Patients requiring a cardiac transplant are generally with advanced, irreversible heart failure with a severely limited life expectancy. These patients would have failed medical and device therapy. Common indications include causes that led to this like- systolic heart failure with a left ventricular ejection fraction less than 35%, ischemic coronary artery disease with refractory angina, intractable life-threatening arrhythmias, cardiomyopathies, and congenital heart disease.


In order for a patient to be recommended for a heart transplant they will generally have advanced, irreversible heart failure with a severely limited life expectancy.[1] It is important to note that the life expectancy of heart failure has improved over the past two decades due to improvements in both medical therapy (ACE Inhibition, beta-blockers, aldosterone antagonists and device therapy such as automatic implantable cardiac defibrillators AICDs and cardiac resynchronization. Thus, patients should not be considered for cardiac transplantation unless they have failed aggressive medical and device therapy. [2][3]

Systolic Heart Failure with a Left Ventricular Ejection Fraction less than 35%[4]

Due to either:

Ischemic Coronary Artery Disease with Refractory Angina

  • Ischemia which is not amenable to percutaneous or surgical revascularization (coronary artery bypass graft surgery CABG) and is refractory to maximally tolerated medical and/or device therapy. [5]

Intractable life-threatening Arrhythmias


Congenital Heart Disease


  1. Steinman TI, Becker BN, Frost AE, Olthoff KM, Smart FW, Suki WN, Wilkinson AH (2001). "Guidelines for the referral and management of patients eligible for solid organ transplantation". Transplantation. 71 (9): 1189–204. PMID 11397947. Unknown parameter |month= ignored (help)
  2. 2.0 2.1 2.2 Alraies MC, Eckman P (2014). "Adult heart transplant: indications and outcomes". J Thorac Dis. 6 (8): 1120–8. doi:10.3978/j.issn.2072-1439.2014.06.44. PMC 4133547. PMID 25132979.
  3. Canter CE, Shaddy RE, Bernstein D, Hsu DT, Chrisant MR, Kirklin JK; et al. (2007). "Indications for heart transplantation in pediatric heart disease: a scientific statement from the American Heart Association Council on Cardiovascular Disease in the Young; the Councils on Clinical Cardiology, Cardiovascular Nursing, and Cardiovascular Surgery and Anesthesia; and the Quality of Care and Outcomes Research Interdisciplinary Working Group". Circulation. 115 (5): 658–76. doi:10.1161/CIRCULATIONAHA.106.180449. PMID 17261651.
  4. Mehra MR, Canter CE, Hannan MM, Semigran MJ, Uber PA, Baran DA; et al. (2016). "The 2016 International Society for Heart Lung Transplantation listing criteria for heart transplantation: A 10-year update". J Heart Lung Transplant. 35 (1): 1–23. doi:10.1016/j.healun.2015.10.023. PMID 26776864.
  5. Lund LH, Edwards LB, Dipchand AI, Goldfarb S, Kucheryavaya AY, Levvey BJ; et al. (2016). "The Registry of the International Society for Heart and Lung Transplantation: Thirty-third Adult Heart Transplantation Report-2016; Focus Theme: Primary Diagnostic Indications for Transplant". J Heart Lung Transplant. 35 (10): 1158–1169. doi:10.1016/j.healun.2016.08.017. PMID 27772668.
  6. Thrush PT, Hoffman TM (2014). "Pediatric heart transplantation-indications and outcomes in the current era". J Thorac Dis. 6 (8): 1080–96. doi:10.3978/j.issn.2072-1439.2014.06.16. PMC 4133537. PMID 25132975.

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