Heart Transplant

Covers human heart transplantation and retransplantation for carefully selected individuals with irreversible, refractory, symptomatic end‑stage heart failure — including pediatric candidates meeting OPTN/UNOS criteria and candidates listed UNOS Status 1–6 (not inactive) with organ allocation priority per OPTN/UNOS. Major limitations: no coverage if the transplant or donor organ was procured in countries designated as participating in forced organ harvesting (e.g., China), the procedure is considered experimental for indications outside the stated criteria, and candidates with contraindications such as active/high‑risk recent malignancy, untreated systemic infection, significant psychosocial/substance‑use issues, fixed pulmonary hypertension, or failure to exhaust maximal medical therapy are ineligible.

"Human heart transplant is considered medically necessary for carefully selected individuals with irreversible, refractory, and symptomatic end-stage heart failure who meet transplant eligibility cr..."