If you have questions about eligibility or the referral process, please contact Apple – [email protected]
Wish Eligibility Criteria are child-focused, dynamic and inclusive. The guidelines and
principles shall evolve with medical advancement. In determining wish eligibility and the
child’s medical needs relating to a wish, there will be a reliance upon the advice of the
primary treating physician and your local medical advisory.
Medical principles of wish eligibility
1. A child or a young adult aged 3 to 18 years old
2. Has not received a wish from another wish-granting organization
3. Diagnosed with a critical illness condition currently placing the child’s life in a life-
threatening stage or with extreme long-term complications.*
*Critical illnesses include, but are not restricted to: childhood cancers, certain types of muscular dystrophy, certain
neurological or genetic diseases, cardiac disorders, renal failure and traumatic injuries. Please speak with us or
contact your doctor for more information.
Principles to determine critical illness conditions
1. Children whose current medical condition requires high-risk therapy to survive may
qualify for a wish.
2. Children who are dependent on technology to survive may qualify for a wish.
3. Children with chronic conditions who demonstrate extreme long-term complications
may qualify for a wish.
4. Children at high risk of death not covered by other criteria on this list may qualify for
a wish.
If you have questions about eligibility or the referral process, please contact Apple – [email protected]
RHEUMATOLOGY
Referral Guidance Sheet
U
SUALLY
qualifying Rheumatology
CONDITIONS
:
•
Antiphospholipid syndrome with
recurrent thrombosis/active disease
(not just positive antibody titers)
•
Autoinflammatory conditions
e.g., TRAPS, CINCA/NOMID, HIDS,
CANDLE, DIRA
•
Chronic vasculitis:
o
Eosinophilic granulomatosis
with polyangiitis
o
Granulomatosis
o
Microscopic polyangiitis
o
Polyangiitis
o
Polyarteritis nodosa
o
Takayasu arteritis
•
Juvenile dermatomyositis
o
With any end-organ involvement, calcinosis, or
otherwise recalcitrant (greater than one year of
treatment or two or more relapses)
•
Mixed connective tissue disease with
end-organ involvement
•
Pediatric systemic lupus erythematous
with end-organ involvement
•
Polychondritis resulting in end-organ damage
•
Progressive Systemic Sclerosis (Systemic Scleroderma)
•
Systemic JRA/JIA with macrophage
activation syndrome (MAS)
Referred within 12 months of MAS episode or
having continuing MAS issues
Other conditions that may be eligible for a wish with complicating comorbidities:
•
Complications from immunosuppressive therapy • Many other conditions not listed
Abby, 11
biliary atresia
If you have questions about eligibility or the referral process, please contact Apple – [email protected]
I wish to
fly like a
butterfly
Claudia, 6
leukemia
PULMONARY
Referral Guidance Sheet
U
SUALLY
qualifying Pulmonary
CONDITIONS
:
•
Chronic hypoxemia requiring
supplemental oxygen
•
Chronic respiratory failure
•
Chronic ventilator dependence
•
Cystic fibrosis
•
Lung transplant
•
Moderate to severe lung disease secondary
to chemotherapy and radiation
•
Placement on the lung transplant list
•
Progressive histiocytosis, including multifocal
•
Progressive interstitial lung disease
associated with immunodeficiency,
autoimmune disease, or immune
dysregulation
•
Pulmonary fibrosis
•
Pulmonary graft versus host disease
•
Pulmonary hypertension
•
Pulmonary lymphangiectasia
•
Severe respiratory compromise incompletely
responsive to therapy and resulting in
recurrent life-threatening episodes
•
Surfactant protein dysfunction
•
Tracheostomy placement for chronic
respiratory failure or severe airway
obstruction
•
Complex Severe Bronchiectasis
Other conditions that may be eligible for a wish with complicating comorbidities:
• Acute respiratory failure
• Bronchopulmonary dysplasia
• Children having a tracheotomy with oxygen requirements
(depending on the underlying medical diagnosis or reason for
the tracheotomy)
• Chronic obstructive pulmonary disease
• Primary ciliary dyskinesia
• Severe asthma
• Severe restrictive lung disease
• Complications from immunosuppressive therapy
• Many other conditions not listed
If you have questions about eligibility or the referral process, please contact Apple – [email protected]
ONCOLOGY
Referral Guidance Sheet
I wish to have
a gaming PC
Dimitris, 15
leukemia
U
SUALLY
qualifying Oncology
CONDITIONS
:
•
Bone marrow/stem cell transplant
•
Low grade tumors with any of the following
criteria:
o
Requiring chemotherapy infusions or radiation
treatment and referred within one year of completion
of the above mentioned treatment
o
Requiring more than one major surgery, such as
craniotomy
o
Location of tumor requiring ongoing medical
intervention (e.g., seizures or endocrine deficit,
significant functional impairment such as paralysis, or
other major neurologic impairment)
o
Associated with extensive complications (e.g.; a lengthy
unplanned hospital stay)
•
Malignant neoplasm and neoplasm of
unspecified/uncertain behavior
o
Requiring and referred within one year of completion
of chemotherapy infusions or radiation treatment
•
Status post bone marrow/stem cell transplant
(with ongoing life-threatening complications)
Other conditions that may be eligible for a wish with complicating comorbidities:
•
Complications from immunosuppressive therapy • Many other conditions not listed
If you have questions about eligibility or the referral process, please contact Apple – [email protected]
NEUROLOGY
Referral Guidance Sheet
I wish to have a
themed birthday
party
Harper, 4
leukemia
U
SUALLY
qualifying Neurology
CONDITIONS
:
•
Alpers disease
•
Cerebral palsy with associated
life-threatening complications
o e.g., intractable seizures, compromised
respiratory failure
•
Congenital neuromuscular disease with
respiratory or cardiac complications including:
o
Myotonic muscular dystrophy
o
Duchenne muscular dystrophy
o
Spinal muscular atrophy types 1 and 2
•
Epilepsy/uncontrolled seizures that are:
o
Intractable
o
Refractory
o
Treatment-resistant
•
Familial dysautonomia (Riley-Day)
•
Friedreich’s ataxia
•
Huntington’s disease
•
Leigh syndrome
•
Lennox-Gastaut syndrome that is:
o Intractable
o
Treatment-resistant
•
Leukodystrophy
•
Moyamoya disease
•
Neurodegenerative disease with
significantly shortened life expectancy
•
Neuronal brain iron accumulation (NBIA)
•
Progressive cerebrovascular disease (e.g., stroke) with ongoing
life-threatening complications
•
Profound neurodevelopmental delay with associated life-
threatening comorbidities requiring significant and ongoing
life-sustaining medical support
•
Rett syndrome
•
Tuberous sclerosis, involving the brain or spinal cord
Other conditions that may be eligible for a wish with complicating comorbidities:
• Arhinencephaly
• Encephalopathy
• Hydrocephalus
• Megalencephaly
• Myopathy
• Neurofibromatosis
• Spina bifida
• Many other conditions not listed
If you have questions about eligibility or the referral process, please contact Apple – [email protected]
NEPHROLOGY
Referral Guidance Sheet
I wish to
swim with
the dolphins
Joana, 11
Cystic fibrosis
U
SUALLY
qualifying Nephrology
CONDITIONS
:
•
Chronic kidney disease (stage 3 or greater) with:
o Multiple acute illnesses/exacerbations in the last year
requiring hospitalization
•
Dialysis dependent renal disease
•
Kidney transplant
•
Kidney diseases dependent on long-term
infusions and/or plasma exchange
o e.g., atypical hemolytic uremic syndrome requiring
chronic anticomplement therapy to stay in remission
•
Status post kidney transplant (with ongoing
life-threatening complications)
Other conditions that may be eligible for a wish with complicating comorbidities:
• Refractory nephrotic syndrome
o e.g.; multiple acute illnesses or relapses requiring
infusion medication and multiple immunosuppressive
medications
• Complications from immunosuppressive therapy
• Many other conditions not listed
If you have questions about eligibility or the referral process, please contact Apple – [email protected]
IMMUNOLOGY &
INFECTIOUS DISEASE
Referral Guidance Sheet
I wish to have
a Pittburgh
Steelers
Experience
Joey, 9
leukemia
U
SUALLY
qualifying Immunology and
I
NFECTIOUS
DISEASE
CONDITIONS
:
•
Bone marrow transplant
•
Immunodeficiencies with:
o
Severe autoimmune complications and/or significantly
diminished life expectancy
•
Primary immunodeficiencies requiring lifelong
treatment
o
Life expectancy is anticipated to be significantly
shortened if the treatment is not available
o e.g., Wiskott-Aldrich, Bruton’s agammaglobulinemia,
chronic granulomatous disease
•
Primary immunodeficiency diseases resulting
in frequent unplanned hospitalizations where
infection is not well controlled
•
Severe combined immunodeficiency disease
(SCID)
•
Status post bone marrow transplant (with ongoing
life-threatening complications)
Other conditions that may be eligible for a wish with complicating comorbidities:
•
Complications from
immunosuppressive therapy
•
HIV
•
Many other conditions not listed
If you have questions about eligibility or the referral process, please contact Apple – [email protected]
HEMATOLOGY
Referral Guidance Sheet
Katya, 8
osteosarcoma
U
SUALLY
qualifying Hematology
CONDITIONS
:
•
Aplastic anemia
•
Bone marrow transplant
•
Hemophagocytic lymphohistiocytosis
•
Severe congenital or acquired bleeding
disorders with:
o
Hemorrhage in vital organs resulting in significant
morbidity (e.g., intracranial hemorrhage with
neurodeficits, organ injury requiring intensive
supportive care, etc.)
o
High titre hemophilic inhibitors resulting in
repeated life-threatening bleeding episodes
•
Severe combined immunodeficiency (SCID)
•
Stem cell transplant (within one year)
•
Severe congenital or acquired blood
cell disorders with:
o
Treatment requiring chemotherapy infusions
o
Serious complications resulting from transfusion therapy
(e.g., iron overload)
•
Sickle cell disease (Hb-SS, Hb-SC) or thalassemia
with severe or chronic complications such as:
o
Acute chest syndrome
o
Splenic sequestration
o
Stroke or severe cerebrovascular disease
o
Necessary regular transfusion
o
Pulmonary hypertension
o
Multiple severe pain crises within past year
o
End organ damage requiring additional
supportive measures
Other conditions that may be eligible for a wish with complicating comorbidities:
•
Complications of immunodeficiency
or from immunosuppressive therapy
•
Coagulation disorders
•
Many other conditions not listed
GENETICS
Referral Guidance Sheet
I wish to hav
e
my own stilts
house
Luis, 4
leukemia
U
SUALLY
qualifying GENETICS
CONDITIONS
:
•
Barth syndrome
•
Congenital anomaly, chromosomal, or single
gene condition with associated life-threatening
complications such as:
o
Intractable seizures
o
Structural upper airway abnormalities or
chronic pulmonary symptoms
o
Heart anomalies meeting cardiology guidance
o
Chronic renal failure
o
Associated major gastrointestinal dysfunctions
•
Skeletal dysplasias or dysostoses with chronic
or degenerative pulmonary complications
•
Trisomy 13 and 18
Other conditions that may be eligible for a wish with complicating comorbidities:
•
Complications from immunosuppressive therapy • Many other conditions not listed
If you have questions about eligibility or the referral process, please contact Apple – [email protected]
GASTROENTEROLOGY
Referral Guidance Sheet
I wish to ride
a firetruck
MATTHIAS,
3
rhabdomyosarcoma
U
SUALLY
qualifying
G
ASTROENTEROLOGY
CONDITIONS
:
•
Bowel/Intestinal transplant
•
Chronic progressive liver disease with
decompensation
•
Hepatopulmonary syndrome
•
Inflammatory bowel disease resulting in
short gut disease with:
o
Prolonged parenteral support
o
Complications resulting from
immunosuppressive therapy or surgery
•
Liver failure
•
Liver transplantation
•
Malignancy or inherited premalignant conditions
•
Portal hypertension
•
Short bowel syndrome or intestinal failure
requiring prolonged parenteral (TPN) support
•
Status post liver transplant (with ongoing
life-threatening complications)
Other conditions that may be eligible for a wish with complicating comorbidities:
•
Atresia of bile ducts
•
Complications from immunosuppressive therapy
•
Crohn’s disease
•
Hirschsprung’s disease
•
Pancreatitis
•
Ulcerative colitis
•
Many other conditions not listed
If you have questions about eligibility or the referral process, please contact Apple – [email protected]
ENDOCRINOLOGY &
METABOLIC CONDITIONS
Referral Guidance Sheet
U
SUALLY
qualifying Endocrinolgy
CONDITIONS
:
•
Disorder of glycosaminoglycan metabolism
•
Disorder of urea cycle metabolism
•
Fabry (Anderson) disease
•
Gaucher disease
•
Hyperinsulinism with persistent
hypoglycemia after pancreatectomy
•
Krabbe disease
•
Lesch-Nyhan syndrome
•
Maple syrup urine disease
•
Metachromatic leukodystrophy
•
Multiple endocrine neoplasia syndromes
with evidence of cancer
•
Niemann-Pick disease
•
Panhypopituitarism requiring hormone
replacement with hydrocortisone and/or
desmopressin
•
Peroxisomal disorder
•
Prader-Willi syndrome with comorbidities
•
Sphingolipidosis
•
Tay-Sachs disease
•
Thyroid cancer
o
Requiring chemotherapy infusions or radiation
treatment and referred within one year of completion of
the above mentioned treatment
•
X-linked adrenoleukodystrophy (all others will be
reviewed on a case-by-case basis)
Other conditions may be eligible for a wish with complicating comorbidities.
If you have questions about eligibility or the referral process, please contact Apple – [email protected]
Zoe, 13
diffused brain stem
glioma
CARDIOLOGY
Referral Guidance Sheet
U
SUALLY
qualifying Cardiology
CONDITIONS
:
•
Complex congenital heart disease, such as:
o
Single ventricle
o
Double inlet left ventricle
o
Tricuspid atresia
o
Aortic atresia
o
Mitral atresia
o
Hypoplastic left heart syndrome
•
Congestive heart failure
•
Hypertrophic, restrictive, and/or
arrhythmogenic right ventricular
cardiomyopathy (ARVC)
•
Implanted cardiac defibrillator
•
Implanted ventricular assist device
•
Left ventricular heart failure
•
Long QT syndrome
•
Necessary frequent hospitalizations after repair
of a congenital heart defect (routine studies requiring
hospitalization are not included)
•
Placement on the heart transplant list
•
Pulmonary arterial hypertension
•
Recipient of a heart or heart-lung transplant
•
Status post Fontan procedure
•
Tetrology of Fallot with pulmonary atresia and
major aortopulmonary collaterals
•
Ventricular fibrillation
Other conditions that may be eligible for a wish with complicating comorbidities:
•
Common arterial trunk
•
Complications from immunosuppressive therapy
•
Double outlet right ventricle
•
Discordant ventriculoarterial connection
•
Heart failure
•
Pacemaker implantation
•
Subaortic stenosis
•
Tetralogy of Fallot
•
Many other conditions not listed
If you have questions about eligibility or the referral process, please contact Apple – [email protected]
Transplant criteria guidelines
1. All children with a transplant are always eligible for a wish (even for children
with transplant prior to the age of eligibility) if they are between the age of 3
to 18 at the time of referral.
2. The Medical Advisory Committee recommends that healthcare professionals
refer children within the first year after undergoing a transplant. This is when
the child may need a wish the most. A wish is less likely to be impactful to a
child the further the child is away from their transplant. Some children may
not be able to participate in certain kinds of wishes in the first year following
the transplant, and in some cases the wish may need to be postponed. Still we
encourage affiliates and their medical advisory team to discuss the variety of
wishes a child may have following a transplant. Affiliates are encouraged to
be mindful of the medical and voluntary hold policies and to have open and
honest discussions with the child’s medical teams and families about timely
wishes.