Consultant cardiac transplant surgeons: There should be a team of cardiovascular surgeons with good experience in performing open heart surgeries, who should have performed adequate number of pump cases per year (more than 200) and who are fully certified and experienced from one of the recognized heart centers internationally.

ICU specialists: An ICU specialist with adequate experience in follow-up of patients after open heart surgery and preferably having adequate experience in follow-up of cardiac transplant recipients.

Consultants in cardiology: They should have adequate experience in dealing with pre-and post-heart transplant patients as well as in performing all relevant cardiac investigations including endomyocardial biopsy.

Nursing Staff: They must be highly experienced to care for the patients during and after heart transplantation.

Organ transplant coordinator.

Social worker.

Dietitian.

Departments of Gastroenterology, Radiology, Hematology, Pathology, laboratory, Biochemical laboratory, Nephrology with hemodialysis unit and Immunology.

At least two fully equipped open-heart surgical theaters equipped with circulatory support systems, e.g., intra-aortic balloon pump, by-pass support systems or mechanical assist devices with the availability of technicians necessary to handle them. -- A fully equipped ICU should be available for management of patients after open-heart surgery with facilities to isolate patients as well as installation of pacemakers, both temporary and permanent.

Fully certified Nephrologists experienced in the follow-up of organ transplant recipients.

Immunologists experienced in follow-up of heart transplantation.

Certified pathologists with experience in interpreting myocardial biopsies.

First: All patients who have end-stage cardiac disease unresponsive to adequately supervised medical therapy and not amenable to any currently acceptable medical or surgical treatment. (left ventricular ejection fraction less than 20%).

Second: Patient should be categorized in NYHA functional class III-IV.

Third: Patient having unresectable cardiac tumors.

Fourth: Patients who fail to come off cardio-pulmonary bypass.

Fifth: Patient that are dying from acute myocardial infarction.

Priority 1. Patients on mechanical cardiac support or on ventilator or cannot be weaned off inotropic support or those who fail to come off cardio-pulmonary bypass.

Priority 2. Patients who require inotropic support, with no requirement for ventilation or mechanical cardiac support.

Priority 3. Patients who are on the waiting list and are waiting at home.

Each heart transplant center should establish a local waiting list, which should be sent to the Saudi Center for Organ Transplantation so that a national waiting list could be made according to priority criteria. The heart transplant center could change the patient’s priority level between the previously mentioned categories according to the patient’s condition, after informing the Saudi Center for Organ Transplantation about this.

All transplant centers should inform the Saudi Center for Organ Transplantation about patients who need urgent heart transplantation so that they can be put in a special urgent waiting list in Saudi Center for Organ transplantation.

Patients in the urgent waiting list have the absolute priority wherever they are, because patients on priority I do not follow the rota system.

If there is no suitable patient* in the urgent waiting list, the heart will be transplanted in the heart transplant center according to the rota. If the center does not have a suitable patient, the heart will be given to the center which has a suitable patient in which case the selection of the patient will be according to blood group and the date from which the patient is registered in the local waiting list.