Selection and treatment of candidates for heart transplantation.

Improved outcome of heart failure in response to medical therapy, coupled with a critical shortage of donor organs, make it imperative to confine heart transplantation to patients who are most disabled by heart failure and who are likely to derive the maximum benefit from heart transplantation. Hemodynamic and functional indices of prognosis (such as peak exercise oxygen consumption) has improved the ability to identify adult patients who should be selected for heart transplantation. These patients should have a poor prognosis despite optimization of medical and surgical therapy. When deciding the impact of individual comorbid conditions on a patient's candidacy for heart transplantation, the detrimental effects of each comorbid condition on post heart transplantation outcome should be weighed. Evaluation of patients with severe heart failure should be done by a multidisciplinary team expert in the management of heart failure, performance of cardiac surgery in patients with low left ventricular ejection fractions, and transplantation. Potential heart transplantation candidates should be reevaluated on a regular basis to assess the continued need for heart transplantation.