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• Systemic illness with a life expectancy of less than 2 years despite HT, including
  • Active or recent solid organ or blood malignancy in the last 5 years
  • AIDS complicated by frequent opportunistic infections
  • Active diseases with multisystem involvement like- systemic lupus erythematosus, sarcoidosis, or amyloidosis
  • Irreversible renal or hepatic dysfunction
  • Significant obstructive pulmonary disease
• Fixed or irreversible pulmonary hypertension defined by the following findings-
  • Pulmonary artery systolic pressure >60 mm Hg
  • Mean transpulmonary gradient >15 mm Hg
  • Pulmonary vascular resistance >6 Wood units

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• Age – Patients are considered for cardiac transplant if they are < 70 years of age; or carefully selected patients over age 70.
• Obesity– BMI > 35 kg/m 2 is associated with a worse outcome.
• Cancer– Careful assessment of each neoplasm with a collaboration with oncology specialists to stratify each patient must be done. ^[3]
• Diabetes– End-organ damage and persistent poor glycemic control (glycosylated hemoglobin [HbA 1c] > 7.5% or 58 mmol/mol) are relative contraindications
• Renal dysfunction– Irreversible renal dysfunction ( eGFR < 30 ml/min/1.73 m 2) is a relative contraindication
• Peripheral vascular disease– Clinically severe symptomatic cerebrovascular disease may be considered a contraindication.
• Infections– Use of immunosuppressive therapy post-transplantation may cause a flare up of active infections.
  • Human immunodeficiency viral (HIV) infection
  • Chagas disease
  • Tuberculosis
  • Hepatitis B and C viral (HBV and HCV) infections
• Tobacco use– Active tobacco smoking is a relative contraindication.
• Substance Abuse– Active substance abusers (including alcohol) cannot receive a heart transplant.
• Psychosocial evaluation– Lack of social support of presence of cognitive disability are relative contraindications.

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