How Social Security Evaluates Heart Transplant Recipients for Disability

Heart transplants do not come without risk and may cause additional impairments to the body. When the Social Security Administration (SSA) evaluates heart transplants recipients, they will consider the amount of time since your transplant and any impairments that continue after the transplant.

Risk Factors for Heart Transplant Recipients

To understand how the SSA evaluates heart transplant recipients, you must know the type of complications that may arise after heart transplants. Those who have had a heart transplant have the following risks.

Failure of the New Heart

Once a heart transplant is completed, it is possible that the donor heart will not work properly. There are two main reasons for a donor heart not to work properly.

• Primary graft dysfunction occurs shortly after the transplant and is the leading cause of death within 30 days of the transplant. This occurs when the donor heart does not function properly and cannot provide the necessary pumping actions to support the body.
• Cardiac allograft vasculopathy (CAV) is a hardening of the arteries in the donor heart, which destroys circulation in the heart. CAV can lead to heart attacks, heart failure, and arrhythmias. This occurs over time.

Rejection of the Heart by the Body

Rejection of the organ is the biggest concern with any transplant. It occurs when the body attacks the new organ because it sees it as a foreign object and threat to the body. There are three types of rejection.

• Hyperacute rejection occurs when the donor organ is not a proper match with the recipient's body. If this occurs, the organ must be removed immediately or the recipient will die.
• Acute rejection occurs to some extent with every transplant. These types of rejections can be treated with medications to prevent failure of the donor organ.
• Chronic rejection occurs when there are continuous and multiple acute rejections of the donor organ. These types of rejections slowly damage the donor heart and may lead to failure of that organ.

Complications From Anti-Rejection Medications

Medications that prevent your body from rejecting the donor heart are essential after a transplant and are needed for the rest of your life. However, they can cause significant effects on the body. Those who are on anti-rejection medications are at increased risk for the following due to the anti-rejection medication.

• kidney damage (this is the most common effect of long term medication use)
• infection (these infections are often severe and lead to hospitalizations. Infections are the leading cause of death from heart transplants in the first year.)
• thinning of the bones
• high blood pressure
• high cholesterol
• cancer (the most common type of cancers seen in heart transplant recipients include skin cancer and non-Hodgkin's lymphoma), and
• diabetes.

Problems From Not Properly Following a Care Plan

After a heart transplant, there are lifelong treatments that need to be followed in order to insure that the donor organ is not rejected. These treatments include taking multiple medications on a strict schedule, attending follow up visits with your doctors, carefully monitoring your health for signs of organ rejection, and living a heart-healthy life style. If the necessary treatments are not followed, you risk rejection of the donor heart or other impairments to the heart.

Rejection or Failure of the Heart Transplant

If your body rejects the donor heart, the SSA will evaluate your impairments under the Compassionate Allowance program, which is a process that allows your disability determination to be made within a matter of days. Alternatively, if you are put on the wait list to receive another heart transplant, you will also qualify for a Compassionate Allowance.

If your impairments progress due to rejection or failure of the heart transplant and your impairments are expected to cause death within six months, you will be eligible for Presumptive Disability, which allows individuals to receive SSI disability benefits while they wait for disability determinations to be made.

Meeting the Disability Listing for Heart Transplants

In evaluating your level of impairment after a heart transplant, the SSA will refer to Listing 4.09, Heart Transplant, in the Social Security "Blue Book," which outlines impairments that will automatically qualify for disability benefits.

All heart transplant recipients are automatically deemed disabled for one year following the transplant surgery.

Meeting Other Disability Listings

• Listing 1.06/.07- Bone fractures (due to bone thinning)
• Listing 4.02- Chronic heart failure
• Listing 4.04- Coronary artery disease
• Listing 4.05- Arrhythmia
• Listing 6.02- Kidney problems
• Listing 9.00- Diabetes
• Listing 13.03- Skin cancer
• Listing 13.05- Lymphoma