| Transplant Section - Heart, Lung, and Heart-Lung
Transplant
| Topic: Heart, Lung, and
Heart-Lung Transplant |
Date of Origin: 04/2008 |
| Section: Transplant |
Policy No: 41 |
| Approved Date: 10/14/2008 |
Effective Date: 11/01/2008 |
| Next Review Date: 11/2011 |
IMPORTANT REMINDER
This Medical Policy has been developed through consideration of medical necessity,
generally accepted standards of medical practice, and review of medical literature
and government approval status.
Benefit determinations should be based in all cases on
the applicable contract language. To the extent there are any conflicts
between these guidelines and the contract language, the contract language will
control.
The purpose of medical policy is to provide a guide to coverage. Medical Policy
is not intended to dictate to providers how to practice medicine. Providers
are expected to exercise their medical judgment in providing the most appropriate
care.
Description
Heart Transplant
A heart transplant consists of replacing an end-stage
diseased heart with a healthy donor heart.
Lung and Lobar Lung Transplant
A lung transplant refers to single-lung or double-lung
replacement. In a single-lung transplant, only one
lung from a cadaver donor is provided to the recipient.
In a double-lung transplant, the recipient’s
lungs are removed and replaced by the donor’s
lungs.
In a lobar transplant, a lobe of the donor’s
lung is excised, sized appropriately for the recipient’s
thoracic dimensions and transplanted. When a bilateral
transplant is required, one lobe is obtained from each
of two donors. Donors for lobar transplant are primarily
living, related donors, although there are also cases
of cadaver lobe transplant.
Heart-Lung Transplant
A heart-lung transplant refers to the transplantation
of one or both lungs and heart from a single cadaver
donor. A combined heart-lung transplant is intended
to prolong survival and improve function in patients
with end-stage cardiopulmonary or pulmonary disease.
Policy/Criteria
- Heart Transplant
A human heart transplant may be considered medically
necessary for patients with end-stage heart failure.
- Lung and Lobar Lung Transplant
- Lung transplantation may be medically necessary
for patients with irreversible, progressively
disabling, end-stage pulmonary disease.
- A lobar lung transplant may be considered medically
necessary for children and adolescents with end-stage
pulmonary disease.
- Heart-Lung Transplant
Heart-lung transplantation may be medically necessary
for patients with end-stage cardiac and pulmonary
disease.
Position Summary
Transplantation for end-stage heart and lung disease
results in improved patient survival. Both the
Scientific Registry of Transplant Recipients (SRTR)
(4) and the International Society for Heart and Lung
Transplantation (ISHLT)(5) report the following survival
statistics for heart, lung and heart-lung transplants:
| |
|
Survival |
| |
|
1-year |
3-year |
Heart transplant |
SRTR |
87.8% |
80.3% |
| |
ISHLT |
86.3% |
79.2% |
Lung transplant
|
SRTR |
83.8%
Deceased donor |
69.5%
Deceased donor |
| |
ISHLT |
83.2% |
67.5% |
Heart-Lung |
SRTR |
76.0% |
38.0% |
| |
ISHLT |
72.5% |
56.4% |
References
- BlueCross BlueShield Association Medical Policy
Reference Manual, Policy No. 7.03.09
- BlueCross BlueShield Association Medical Policy
Reference Manual, Policy No. 7.03.07
- BlueCross BlueShield Association Medical Policy
Reference Manual, Policy No. 7.03.08
- U.S. Organ Procurement and Transplantation Network
and the Scientific Registry of Transplant Recipients. Data
tables. http://www.ustransplant.org/annual_reports/current/data_tables_section12.htm (Verified
8/25/08)
- International Society for Heart and Lung Transplantation. http://www.ishlt.org/registries/quarterlyDataReport.asp (Verified
8/25/08)
Cross References
None
| Codes |
Number |
Description |
CPT |
32850 |
Donor pneumonectomy (including
cold preparation), from cadaver donor |
|
32851 |
Lung transplant, single; without
cardiopulmonary bypass |
|
32852 |
Lung transplant, single; with
cardiopulmonary bypass |
|
32853 |
Lung transplant, double (bilateral,
sequential, or en bloc); without cardiopulmonary
bypass |
|
32854 |
Lung transplant, double (bilateral,
sequential, or en bloc); with cardiopulmonary
bypass |
|
32855 |
Backbench standard preparation
of cadaver donor lung allograft prior to transplantation,
including dissection of allograft from surrounding
soft tissues to prepare pulmonary venous/atrial
cuff, pulmonary artery, and bronchus; unilateral |
|
32856 |
Backbench standard preparation
of cadaver donor lung allograft prior to transplantation,
including dissection of allograft from surrounding
soft tissues to prepare pulmonary venous/atrial
cuff, pulmonary artery, and bronchus; bilateral |
|
33930 |
Donor cardiectomy-pneumonectomy,
(including cold preparation) |
|
33933 |
Backbench standard preparation
of cadaver donor heart/lung allograft prior to
transplantation, including dissection of allograft
from surrounding soft tissues to prepare aorta,
superior vena cava, inferior vena cava,
and trachea for implantation |
|
33935 |
Heart-lung transplant with recipient
cardiectomy-pneumonectomy |
|
33940 |
Donor cardiectomy (including
cold preservation) |
|
33944 |
Backbench standard preparation
of donor cadaver heart allograft prior to transplantation,
including dissection of allograft from surrounding
soft tissues to prepare aorta, superior vena
cava, inferior vena cava, pulmonary artery, and
left atrium for implantation |
|
33945 |
Heart transplant, with or without
recipient cardiectomy |
HCPCS |
S2060 |
Lobar lung transplantation |
|
S2061 |
Donor lobectomy (lung) for transplantation,
living donor |
Transplant Section Table of Contents 
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