The case for selective re-issuance of medical certificates to allow pilots who have received a heart transplant to resume flying.

Academic Article


  • BACKGROUND: Cardiac transplant recipients have been regarded as not medically fit to fly an airplane. Recently, the Federal Aviation Administration decided to re-examine this policy and, in response, this study was undertaken to determine the risk of death from any cause and sudden-onset death in heart transplant recipients during the 12 months after an annual evaluation. METHODS: Of 6,510 patients undergoing primary orthotopic cardiac transplantation enrolled in the Cardiac Transplant Research Database (CTRD), 4,978 patients survived for at least 1 year and formed the basis of this study. Risk factors for death from any causes and sudden-onset death (a composite of causes of death that could conceivably result in a pilot's incapacitation) were determined during the 12-month period after an anniversary evaluation. Patients were re-entered into the analysis at each evaluation, resulting in a total of 23,575 anniversary evaluations. RESULTS: The presence of coronary allograft vasculopathy (CAV), left ventricular systolic dysfunction, history of rejection, malignancy, infection and pre-transplant insulin-dependent diabetes were associated with an increased risk of death from any cause and sudden-onset death during the 12-month period after an evaluation. Based on the absence of these risk factors, a group of heart transplant recipients could be defined with a 12-month risk of death from any cause of 1.0% and of sudden-onset death of 0.3% (which is identical to the mortality rate of a matched population from the U.S. life-table). CONCLUSION: Using these identified risk factors, a group of heart transplant recipients can be defined that are potentially medically certifiable to fly without compromising aviation safety.
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    Published In


  • Adolescent, Aerospace Medicine, Cause of Death, Coronary Angiography, Coronary Disease, Diabetes Mellitus, Type 1, Female, Graft Rejection, Heart Transplantation, Humans, Male, Multivariate Analysis, Registries, Risk Factors, Ventricular Dysfunction, Left
  • Digital Object Identifier (doi)

    Author List

  • McGiffin DC; Brown R; Kirklin JK; Naftel DC; Bourge RC; Pritzker MR; Kasper EK; Stevens T; Clemson BS; Smith AL
  • Start Page

  • 259
  • End Page

  • 269
  • Volume

  • 24
  • Issue

  • 3