Heart/Lung Transplant

This policy covers combined heart/lung transplantation for carefully selected patients with end‑stage cardiac and pulmonary disease (for example irreversible pulmonary arterial hypertension with heart failure, severe pulmonary fibrosis, Eisenmenger complex, cystic fibrosis, COPD/emphysema with severe heart failure) and heart/lung retransplantation when criteria are met, following UNOS allocation/prioritization rules. Coverage is subject to the member’s benefit plan and state rules, excludes organs procured from countries designated for forced organ harvesting, treats other indications as experimental/unproven, and requires absence of contraindications such as active/high‑risk malignancy, untreated systemic infection, or significant psychosocial/substance‑use barriers.

"Heart/lung transplantation for carefully selected individuals with end-stage cardiac and pulmonary disease."