Does the patient have less than 1-yr life expectancy?

Cardiogenic shock requiring mechanical support or highdose inotropic/pressor drugs?
Stage D, refractory heart failure symptoms despite maximal therapy?
Recurrent life-threatening arrhythmias despite maximal interventions and implanted defibrillator?
Refractory angina without potential for revascularization?

Yes

Consider permanent mechanical support

Age >65–70 (?) yr?

Yes

No

No

End-of-life considerations or investigational therapy

End

Consider permanent mechanical support

Active or recent malignancy?

Yes

No

No

End-of-life considerations or investigational therapy

FEV/FVC <40%?

Consider permanent mechanical support, unlikely candidate

Diabetes with severe end-organ damage?

Yes

No

No

End-of-life considerations or investigational therapy

Consider heart-lung transplantation

Yes

No

No

End-of-life considerations or investigational therapy

Nutritional modification

BMI <20 or BMI >35–40?

Yes

No

BMI >35–40

Consider permanent mechanical support (VAD) to weight loss

Consider heart-lung transplantation

Irreversible pulmonary hypertension?

Yes

No

No

End-of-life considerations or investigational therapy

Individual transplant team decisions

Determine transplant status and immunologic status

Other comorbidity present? (cirrhosis, vascular disease, addictions, hepatitis C, HIV, social or psychiatric disorders)

Yes

No

Acceptable

List for transplant