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Heart and Circulatory System

Special Issuance Authorization after Heart Transplantation

Special Issuance

The FAA is once again considering for special issuance applicants who have had a cardiac transplant. In the early 1990's, the FAA withdrew the small number of existing heart transplant authorizations because of evidence of post-operative coronary artery disease that was not detectable with conventional diagnostic tests.

Following a lengthy review of transplant literature, the FAA has determined that risks can be effectively managed under strict special issuance guidelines for THIRD-CLASS medical certification only.

For special issuance consideration following heart replacement surgery, the FAA will require:

  • A current report from the treating transplant cardiologist regarding the status of the cardiac transplant, including all pre- and post-operative testing. Included in this report should be a statement regarding functional capacity, modifiable cardiovascular risk factors, and prognosis for incapacitation;
  • Current blood chemistries (fasting blood sugar, hemoglobin A1C concentration, and blood lipid profile to include total cholesterol, HDL, LDL, and triglycerides), performed within the preceding 30 days;
  • Any tests performed or deemed necessary by the treating physicians (e.g., periodic myocardial biopsy);
  • A post-operative coronary angiogram;
  • Maximal graded exercise treadmill stress test;
  • Exercise Stress Echocardiogram;
  • 24-hour Holter monitor evaluation to include selective representative tracings;
  • Complete documentation of all rejection history, whether treated or not. Include hospital records and reports of any tests done;
  • A complete history regarding any infectious process;
  • All complete history regarding any malignancy;
  • List of all present medications and dosages, and note of any side effects.
  • All testing must be completed and submitted to the FAA within 30 days.

You should have all records available when you see the aviation medical examiner for an FAA physical exam. The Examiner must defer the application to the FAA for a decision. Consideration will be for Third-class applicants only. The FAA Cardiology Consultant Panel will review all cases. Subsequent recertification will be based on annual follow-up evaluation.  All information should be forwarded by express mail to the FAA in Oklahoma City.

How/Where to Submit to the FAA

Helps you find the contact information for submitting your medical records.

Updated May 28, 2020