When to transplant: Recipient selection for heart transplantation.

Heart transplantation is an accepted therapeutic alternative for patients with end-stage heart failure. The most common diagnoses of patients who require heart transplantation are ischemic and nonischemic cardiomyopathy. Evaluation for heart transplantation involves an examination of the patient's heart disease including left ventricle ejection fraction, hemodynamic status, presence of ventricular ectopy, New York Heart Association functional class, symptoms, exercise tolerance, and sympathetic nervous system activation. In addition, absolute and relative contraindications must be identified to determine their influence on a patient's candidacy. Care must be taken to determine the best use of a donor heart, a scarce resource, with regard to posttransplant morbidity, mortality, and quality of life.