title: Cardiac transplantation in adult patients with mental retardation: do outcomes support consensus guidelines?
abstract: BACKGROUND
  Selection criteria guidelines list mental retardation as a relative contraindication to heart transplantation, but not to kidney transplantation.
  
  
  OBJECTIVE
  The authors present a case series of adults with mental retardation or comparable acquired intellectual disability who underwent heart transplantation. They discuss the literature on heart and kidney transplantation in people with mental retardation and the ethical reasoning that guides how recipients of solid organ grafts are chosen.
  
  
  METHODS
  Literature review and retrospective review of long-term outcomes for five adult patients with mental retardation or comparable disability who received heart transplants.
  
  
  RESULTS
  Among these cases, survival times to date ranged from 4 to 16 years, with a median survival of greater than 12 years. Medical non-adherence was a significant factor in only 1 of the 5 cases. In that case, the patient's medical non-adherence was due to a functional decline in the primary caretaker.
  
  
  CONCLUSIONS
  People with mental retardation can receive long-term benefit from heart transplantation when they have the cognitive and social support necessary to ensure adherence to post-transplant regimens. There is no ethical or medical reason for guidelines to consider mental retardation, in and of itself, a contraindication to heart transplantation. The totality of the individual patient's circumstances should be considered in assessing transplant candidacy.
authors.affiliation: Department of Psychiatry, New York-Presbyterian Hospital Columbia University Medical Center, New York, NY, USA. ecs2158@columbia.edu
authors.forename: Emma
authors.initials: E
authors.lastname: Samelson-Jones
authors.forename: Donna M
authors.initials: DM
authors.lastname: Mancini
authors.forename: Peter A
authors.initials: PA
authors.lastname: Shapiro
mesh_terms: D000328:Adult; D032921:Consensus; D000075202:Contraindications; D016027:Heart Transplantation / Q000941:ethics / Q000401:mortality; D006801:Humans; D008607:Intellectual Disability; D016030:Kidney Transplantation / Q000941:ethics / Q000401:mortality; D010349:Patient Compliance; D018579:Patient Selection / Q000941:ethics*; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012944:Social Support; D015996:Survival Rate; D014180:Transplantation; D016896:Treatment Outcome