Heart-lung Allocation

Question 1

When registering a candidate for heart transplant, which data points are required from the transplant program? (7 data points)

Answer 1

1. Hemodynamic assessment results
2. Functional status or exercise testing results
3. Heart failure severity or end organ function indicators
4. Heart failure therapies
5. Mechanical support
   6.Sensitization risk, including CPRA, peak PRA, and number of prior sternotomies
6. Current diagnosis

Question 2

Adult heart transplant candidates are assigned a status level based on the urgency of their need. How many status levels are there?

Answer 2

6 status levels, status 1 being the most urgent, status 6 being the least .

Question 3

Adult heart status 1 requires at least 1 of the following conditions (3 conditions):

Answer 3

1. Is supported by veno-arterial extracorporeal membrane oxygenation (VA ECMO)
2. Is supported by a non-dischargeable, surgically implanted, non-endovascular biventricular
   support device
3. Is supported by a mechanical circulatory support device (MCSD) and has a life-threatening
   ventricular arrhythmia

Question 4

Adult heart status 1 has very strict eligibility conditions. How long will this status remain in effect before the transplant program must submit another justification form for status assignment?

Answer 4

7 days (14 days if candidate is supported by an MCSD, and is experiencing recurrent or sustained ventricular tachycardia or
ventricular fibrillation)

Question 5

In order to renew adult heart status 1 for a candidate supported by VA ECMO, what 2 things must the transplant program provide documentation of?

Answer 5

1. candidate demonstrated a contraindication to being supported by a durable device
2. Within 48 hours prior to the status expiring, transplant program failed at weaning the candidate from VA ECMO as evidenced by at least one of the following:
   •Mean arterial pressure (MAP) less than 60 mmHg
   • Cardiac index less than 2.0 L/min/m2
   •Pulmonary capillary wedge pressure greater than 15 mmHg
   •SvO2 less than 50 percent measured by central venous catheter

Question 6

What conditions make a candidate eligible for adult heart status 2? (6 conditions)

Answer 6

1. Supported by non-dischargeable, non-endovascular LVAD
   2.supported by a total artificial heart (TAH), biventricular assist device (BiVAD), right ventricular assist device (RVAD), or ventricular assist device (VAD) for single ventricle patients
2. supported by a mechanical circulatory support device (MCSD) that is malfunctioning
   4.supported by a percutaneous endovascular MCSD
3. supported by an intra-aortic balloon pump (IABP)
4. experiencing recurrent or sustained ventricular tachycardia or ventricular fibrillation

Question 7

Adult heart status 2 remains in effect for how long before needing to be renewed if circumstances haven’t changed?

Answer 7

14 days

Question 8

Adult heart status 3 justifications (12 justifications)

Answer 8

1. Supported by a DISCHARGEABLE LVAD and exercising 30 days discretionary time
2. supported by multiple inotropes or a single high dose inotrope and has hemodynamic
   monitoring
3. Supported by MCSD with hemolysis
4. Supported by MCSD with pump thrombosis
5. Supported by MCSD with right heart failure
6. Supported by MCSD with device infection
7. Supported by MCSD with bleeding
8. Supported by MCSD with aortic insufficiency
9. Supported by VA ECMO after 7 days
10. Supported by non-dischargeable, non-endovascular LVAD after 14 days
11. Supported by percutaneous, endovascular MCSD after 14 days
12. Supported by IABP after 14 days

Question 9

What evidence must be provided for a candidate with an MCSD with hemolysis to be assigned status 3? (2 evidences)

Answer 9

1. Two separate samples collected within 48 hours of each other confirming two of the following criteria:
   • Blood lactate dehydrogenase (LDH) at least 2.5 times the upper limit of normal
   •Plasma free hemoglobin greater than 20 mg/dL
   • Hemoglobinuria
2. Documentation of at least one attempt to treat the condition using an IV anticoagulant, IV anti-platelet agent, or thrombolytic, with persistent or recurrent hemolysis

Question 10

How can pump thrombosis be recognized in a candidate with an MCSD? (2 ways)

Answer 10

1. Visually detected thrombus in a paracorporeal VAD
2. Transient ischemic attack, stroke, or peripheral thromboembolic event, with non-invasive testing to exclude both:
   • Intracardiac thrombus in all candidates
   • Significant carotid artery disease in candidates with a neurological event