Last updated: 11/24/2009

There are factors which absolutely contraindicate (rule out) heart-lung transplantation, including multiple organ system dysfunction, current substance abuse, bone marrow failure, active malignancy, and HIV infection. Other relative contraindications...

include age greater than 55, anorexia, obesity, peripheral and coronary vascular disease, ventilator support, steroid dependency, chest wall deformity, and resistant infections by bacterial and fungal agents. Mental health status should be addressed, as well.

Patients who are limited in daily activity, as defined by their doctors, and have a limited life expectancy, are candidates for heart-lung transplantation. These patients suffer from untreatable end-stage pulmonary, organ, and/or vascular disease. Most often, the diagnosis includes primary pulmonary hypertension brought on by congenital blood vessel defects that include malformations in the lung. Congenital cardiac defects and other diseases may also be responsible.

Donor matching is managed by the Organ Procurement and Transplantation Network (OPTN), in which all organ centers must participate according to Federal Medicare and Medicaid programs. Established criteria for donor organ matching include the following: anatomic and immunologic compatibility between the donor and recipient; medical urgency; efficiency in organ distribution for improved organ viability; and ethical considerations. After a match for anatomic and blood group compatibility with the patients on the donor list, the organs are distributed on the basis of seniority in list standing among suitable recipients. Patients with IPF are provided special consideration on organ donor waiting lists. The average waiting time on the heart-lung transplant list is 795 days.