Cardiac transplantation: recipient selection, donor procurement, and medical follow-up. A statement for health professionals from the Committee on Cardiac Transplantation of the Council on Clinical Cardiology, American Heart Association.

D uring the past decade heart transplantation hasevolved from an experimental procedure per- formed in selected centers to the treatment of choice for patients with end-stage heart disease.The rapid increase in the number of heart transplants performed worldwide is attributable to numerous advances in surgery, tissue preservation, immunology, and infec- tious disease that have resulted in acceptable short-and long-term patient and graft survival.The improved outcome of heart transplantation is also due to the highly specialized care provided by physicians and sur- geons who have made a strong commitment to heart transplantation and have acquired expertise in recipient selection, donor procurement, and medical follow-up before and after transplantation.Standardized criteria help physicians and surgeons identify patients who will likely benefit from heart transplantation.Unfortunately, the limited availability of donor hearts makes it impos- sible to offer transplantation to all potential candidates.The need for an equitable system of donor organ allocation was a factor in the organization of a national organ procurement and distribution network, the United Network for Organ Sharing (UNOS),* which distributes organs based on the severity of the recipi- ent's illness, waiting time, donor and recipient's blood types, and body-size match.In addition to maximizing access to donors and matching organs to specific recipients, other important aspects of a donor procurement program are knowledge of medical, ethical, and legal issues concerning brain death, skill in hemodynamic management of potential donors, and expertise in organ retrieval, preservation, and transport.*UNOS is responsible for maintaining the national computer- ized prioritization and allocation system and certifying transplant centers and local organ procurement organizations."Cardiac Transplantation" was approved by the American