Characteristics of patients referred for cardiac transplantation: Implications for the donor organ shortage

Background When the decision is made to proceed with cardiac transplantatio n, the risk/benefit ratio for continued medical therapy in that particular patient must be weighed against the risk/benefit ratio associated with card iac transplantation. This can only be accomplished while the patient is on maximal medical therapy. Methods To better define the appropriateness of patients being referred for consideration of transplant. we examined the records of 100 consecutive ad ult patients referred to a cardiac transplant program. Results Two of five patients referred for transplantation hod at least one contraindication for transplantation. Twenty percent of the patients were n ot treated with angiotensin-converting enzyme inhibitors and did not have a ny documented reason for undertreatment OF those deemed too well for cardia c transplantation, 84% were alive and either class I or II (mean follow-up 21 months). Conclusions We found the majority to be undertreated or with on absolute co ntraindication to transplantation. Of those deemed too well for transplanta tion after appropriate treatment, 84% were alive and well.