436. Heart Failure: Pre-Heart Transplant Evaluation and Management with Dr. Kelly Schlendorf

Heart transplant evaluation requires a nuanced approach to patient prioritization and donor matching. The current allocation system utilizes six status levels based on medical urgency, hemodynamics, and mechanical circulatory support needs. Wait times are heavily influenced by blood type compatibility, HLA sensitization—measured via Panel Reactive Antibody (PRA) tests—and geographic proximity to donor centers. To address the persistent organ shortage, transplant programs are increasingly utilizing hearts from donors after circulatory death (DCD), as well as hepatitis C and HIV-positive donors, often paired with direct-acting antiviral therapies. While desensitization protocols can help highly sensitized candidates, these strategies involve complex immunosuppressive regimens that carry significant infection risks. Expert Dr. Kelly Schlendorf emphasizes that while the field continues to evolve, successful outcomes depend on balancing patient-specific risks with innovative strategies to expand the available donor pool.