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UK guidelines for referral and assessment of adults for heart transplantation
  1. Nicholas R Banner1,2,3,
  2. Robert S Bonser4,
  3. Andrew L Clark5,
  4. Stephen Clark6,
  5. Peter J Cowburn7,
  6. Roy S Gardner8,
  7. Paul R Kalra9,
  8. Theresa McDonagh2,10,
  9. Chris A Rogers3,11,
  10. Lorna Swan10,
  11. Jayan Parameshwar12,
  12. Helen L Thomas13,
  13. Simon G Williams14
  1. 1The Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, Middlesex, UK
  2. 2National Heart and Lung Institute, Faculty of Medicine, Imperial College, London, UK
  3. 3Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
  4. 4University of Birmingham and Queen Elizabeth Hospital, University Hospital Birmingham NHS Trust, Edgbaston, Birmingham, UK
  5. 5Hull York Medical School, University of Hull, Kingston upon Hull, UK
  6. 6Freeman Hospital, Newcastle upon Tyne, UK
  7. 7Wessex Cardiothoracic Unit, Southampton General Hospital, Southampton, UK
  8. 8Golden Jubilee National Hospital, Clydebank, UK
  9. 9Queen Alexandra Hospital, Southwick Hill Road, Cosham, Portsmouth, UK
  10. 10The Royal Brompton and Harefield NHS Foundation Trust, Royal Brompton Hospital, Sydney, London, UK
  11. 11Bristol Heart Institute, University of Bristol, Bristol, UK
  12. 12Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, UK
  13. 13NHS Blood and Transplant, Fox Den Road, Stoke Gifford, Bristol, UK
  14. 14North West Heart and Transplant Centre, Wythenshawe Hospital, Manchester, UK
  1. Correspondence to Dr Nicholas R Banner, Consultant in Cardiology, Transplant Medicine and Circulatory Support, The Royal Brompton and Harefield NHS Trust, Harefield Hospital, Hill End Road, Harefield, Middlesex UB9 6JH, UK; n.banner{at}


Patients with advanced heart failure have a dismal prognosis and poor quality of life. Heart transplantation provides an effective treatment for a subset of these patients. This article provides cardiologists with up-to-date information about referral for transplantation, the role of left ventricular assist devices prior to transplant, patient selection, waiting-list management and donor heart availability. Timing is of central importance; patients should be referred before complications (eg, cardiorenal syndrome or secondary pulmonary hypertension) have developed that will increase the risk of, or potentially contraindicate, transplantation. Issues related to heart failure aetiology, comorbidity and adherence to medical treatment are reviewed. Finally, the positive role that cardiologists can play in promoting and facilitating organ donation is discussed.

  • Heart failure
  • immunosuppression
  • transplant
  • heart transplant pathology
  • heart failure treatment
  • transplantation
  • vascular surgery
  • aortic root disease
  • preconditioning
  • echocardiography
  • LV dysfunction
  • exercise physiology
  • cardiac resynchronisation
  • left ventricular assist device
  • heart transplant
  • implantable cardioverter defibrillator (ICD)
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  • An up-to-date list of UK heart transplant centres is available on the National Health Service Blood and Transplant website:

  • Referrals may be made to any centre but should take into account geographical access for patients when attending for assessment, transplantation and post-transplant follow-up.

  • Endorsements Cardiothoracic Advisory Group of the National Health Service Blood and Transplant, the British Society for Heart Failure and the Society for Cardiothoracic Surgery in Great Britain and Ireland.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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