Candidate selection for heart transplantation.

The number of patients referred for heart transplantation continues to increase at a rate well beyond the number of available donors. Further attempts to expand the donor pool may be difficult and certainly cannot keep pace with the increased demand. Uniform criteria for candidate selection are critically needed. Significant functional impairment of cardiac origin, as demonstrated by oxygen consumption treadmill testing on maximal medical therapy, should be documented in all patients before considering definitive evaluation for heart transplant. Patients whose peak oxygen consumption is less than 50% of predicted should be seriously considered for transplantation. Similarly, those patients whose peak VO2 is greater than 60% of predicted probably do not warrant listing as transplant candidates in the absence of other significant risk factors, such as malignant ventricular arrhythmias unresponsive to drug therapy or ongoing ischemia not suitable for revascularization. Application of these fairly simple but definitive guidelines should help significantly reduce the number of patients on the transplant waiting list and allow patients with the greatest survival benefit to receive a graft in a much shorter period of time.