Purpose: The purpose of this study was to evaluate the influence of advanced age, obesity and HIV seropositivity on solid organ transplant listing across liver, kidney, heart and lung programs.

Methods: We distributed an online survey to all 650 adult and pediatric heart, kidney, liver, and lung programs in the US; 343 submitted complete responses (response rate = 52.8%). The survey queried the extent to which each patient characteristic is a contraindication to listing and the existence of guidelines for these criteria.

Results: Most programs have absolute contraindications to listing for BMI > 45 (AC 67.5%) and age > 80 (AC 55.4%). Only 28.4% of programs use HIV seropositivity as an absolute contraindication to listing, while 31.6% find it irrelevant. There is variation among organs in listing practices for BMI > 45 (AC heart 70.5%, kidney 70.9%, lung 93.3%, liver 45.9%), age > 80(AC heart 79.2%, lung 76.9%, liver 65.0%, kidney 27.8%). HIV seropositivity (AC heart 34.6%, lung 60.0%, kidney 17.3%, liver 22.4%; IR heart 11.5%, lung 11.1%, kidney 47.2%, liver 37.6%). We found that less than 50% of programs had formal age guidelines for listing while more than 50% had guidelines for BMI cutoff and HIV seropositivity.

Conclusions: There is variability among transplant programs and organ types regarding medical contraindications for transplant listing. While most programs have formal guidelines for BMI and HIV status, these are internal guidelines that are not available to patients. To address variation among programs, it is time to draft universal policies that will minimize biases and improve fairness in the process of making listing decisions.

CITATION INFORMATION: Wall A., Lee G., Maldonado J., Magnus D. Medical Contraindications to Solid Organ Transplant Listing: A Survey of Heart, Liver, Lung and Kidney Programs Am J Transplant. 2017;17 (suppl 3).

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