Heart-Lung Transplantation (CPB 0597, reviewed 2026-09-08)
Aetna considers heart-lung transplantation medically necessary for persons with severe refractory heart failure plus either end-stage lung disease or irreversible pulmonary hypertension, when the selection criteria are met and no absolute contraindications are present. Examples of qualifying conditions include COPD with severe heart failure, cystic fibrosis with severe heart failure, congenital heart disease with pulmonary hypertension that is not amenable to lung transplantation and repair by standard cardiac surgery, and Eisenmenger's complex with irreversible pulmonary hypertension and severe heart failure. Heart-lung transplantation is considered not medically necessary where lung transplantation alone will restore right ventricular function.