For patients with end-stage heart failure, a transplant often feels like the only hope. It is the "gold standard" most advanced treatment option. So, hearing a doctor say, "You are not a candidate for this surgery," can be devastating.

But why would a doctor refuse a life-saving operation?

The reality is that a heart transplant is one of the most physically demanding surgeries a human body can undergo. It requires lifelong immune suppression and rigorous recovery. If a patient is not strong enough to handle the process, the surgery won't save them it might actually shorten their life.

Doctors follow strict eligibility criteria to ensure that every donated heart which is a scarce gift goes to a patient who has the best chance of long-term survival. At Karetrip, we help patients navigate these complex evaluations. Here is a clear guide to the medical reasons why a patient might be considered ineligible.

1. Irreversible Damage to Other Organs

A new heart needs a healthy "environment" to function.

Kidney or Liver Failure: If the patient has severe, irreversible kidney or liver disease, they cannot tolerate the heavy medications (immunosuppressants) required after the transplant. These drugs can cause further organ failure.

Severe Lung Disease: Conditions like COPD or severe Pulmonary Hypertension (high pressure in the lung arteries) are major red flags. If the pressure in the lungs is too high, the new, healthy heart will fail immediately because it isn't strong enough to pump against that resistance.

2. Active Infection or Cancer

The immune system is the key here.

Active Cancer: After a transplant, patients must take drugs to lower their immune system so the body doesn't reject the heart. Unfortunately, these drugs also stop the body from fighting cancer cells, causing tumors to grow rapidly. Most programs require a patient to be "cancer-free" for 3–5 years before listing.

Active Infection: A patient with a severe, uncontrolled infection (like sepsis) cannot undergo surgery until the infection is fully cleared.

3. Advanced Age (The "Biological" Factor)

This is often a "Relative Contraindication," meaning it varies by hospital.

• Generally, patients over 70 years old are considered high risk because their bodies may not recover well from the trauma of surgery.

• However, doctors look at "Biological Age" vs. "Chronological Age." A fit 70-year-old might be eligible, while a frail 60-year-old might not be.

4. Lifestyle Factors (Smoking & Addiction)

Transplant teams require patients to be partners in their own health.

• Active Smoking/Drug Use: Patients must be nicotine and drug-free for at least 6 months before being placed on the waiting list.

• Why? Smoking damages blood vessels and dramatically increases the risk of the new heart failing. If a patient cannot quit before surgery, it is unlikely they will quit after.

5. Lack of a Support System

This surprises many people, but it is a critical factor. Recovering from a heart transplant is a full-time job. It involves dozens of pills daily, frequent biopsies, and strict hygiene.

• If a patient has untreated psychiatric conditions that interfere with treatment adherence (that prevent them from following instructions) or no family/caregiver support to help them at home, the surgery is considered too risky to proceed.

If Not a Transplant, Then What?

Being told "No" for a transplant is not the end of the road. For patients who are ineligible due to age or other conditions, Destination Therapy with an LVAD (Left Ventricular Assist Device) is often an excellent alternative. This mechanical pump can support the heart for years, offering a good quality of life without the need for a donor organ.

Conclusion: Understanding Your Options

Determining eligibility is not a 5-minute decision. It involves weeks of testing by a committee of cardiologists, surgeons, and social workers.

If you have been denied a transplant at one centre, it is often worth getting a Second Opinion. Different hospitals have different risk thresholds.

At Karetrip, we connect you with top transplant centres for a comprehensive review of your case. We assist with:

• Pre-transplant evaluation reviews.
• Connecting you to LVAD specialists if transplant isn't an option.
• Medical travel and accommodation for testing.
• End-to-end patient support.

Want to know if someone is eligible for a heart transplant? Ask Rua. Our AI companion is ready to help you understand the criteria and guide you to the right specialists.

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Medical Disclaimer

The content provided in this blog is for informational and educational purposes only and does not constitute medical advice, diagnosis, or treatment. Organ transplant eligibility is a complex medical decision made by a multidisciplinary hospital committee based on individual health factors. Always seek the advice of your cardiologist or a qualified transplant specialist with any questions you may have regarding eligibility or alternative treatments. Never disregard professional medical advice or delay in seeking it because of something you have read on the Karetrip website. Karetrip does not endorse any specific physicians or procedures mentioned herein. Reliance on any information provided by Karetrip is solely at your own risk.