Guidelines for Listing Candidates for Heart Transplant: A 10-Year Update

Despite strides made in medical therapy for patients with an advanced stage of heart failure, more than 3000 patients are listed for a heart transplant annually in the United States, while only 2200 to 2400 transplants are performed during the same time period.¹ Evidence for this growing demand was particularly noted after the Affordable Care Act was enacted, when it has been shown that heart transplant listings increased during this time period.² Static transplant rates have led to the argument for greater vigilance in listing patients, and appeals to trim the waiting list have emerged.³ Increasingly, solutions to expand the donor pool have also surfaced.⁴ More recently, alterations in the allocation system, to address vulnerable populations or to discourage attempts at higher urgency listing for those not eligible, are being entertained.⁵ Appropriate listing and timing, dynamic delisting, and efforts to provide vulnerable populations (such as those with congenital heart disease or infiltrative cardiomyopathy, as well as those who harbor chronic infections) were key features of the output of these guidelines under discussion.⁶