Heart transplantation can improve the patient’s life expectancy and also his quality of life. As there is acute shortage of organs, every patient cannot be a beneficiary.
If it is left to the market forces, then the available heart may go to the highest bidder. Hence there has to be a criterion to ensure that the precious resource is allocated in a manner to ensure maximum benefit.
The ideal heart transplant candidate is a person with end-stage heart disease. The conventional therapy may not provide him benefit and improvement in life expectancy. People with following heart conditions may be the candidates for heart transplant.
- Inoperable coronary artery disease
- Dilated cardiomyopathy
- Restrictive cardiomyopathy
- Infiltrative cardiomyopathy
- Complex congenital heart disease
- Inoperable valvular heart disease
- Hypoplastic left heart syndrome in the neonate
Healthcare Financing Administration (HFCA) included covering heart transplant from the fiscal year 1987 under Medicare heart transplants. It was predicted that 65 procedures would be covered in the first year and it may go up to 143 procedures in the fifth year.
The number of Medicare covered heart transplants depends on three factors:
- Demand for heart transplants in Medicare eligible
- Supply of organ donors whose hearts become available for transplant
- The degree of success in matching waiting persons with available donors
It was estimated that as many as 85,000 Medicare eligible persons would develop end stage heart disease and become eligible for transplant. The age selection criterion of no younger than age ten and no older than age fifty-five was applied and the eligible figure came down drastically to 1012 persons. If the medical and psychological suitability is applied the number comes down to 140 as candidates. Only 60 percent were expected to survive the wait for the matching donor. On that basis a forecast of 65 to 143 recipients was worked out for five years.
For the year 1987, against the forecast of 65 heart transplants, HFCA received claims for 50 patients. About half of the 50 claims were for patients older than age 55 and there were 3 patients who were 65 or older. The persons beyond the maximum age of 55 are routinely accepted as transplant candidates.
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