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. 2020 Oct;20(10):2781-2790.
doi: 10.1111/ajt.16010. Epub 2020 Jun 14.

A change of heart: Preliminary results of the US 2018 adult heart allocation revision

Rebecca R Goff  1 , Kimberly Uccellini  1 , Kelsi Lindblad  1 , Shelley Hall  2 , Ryan Davies  3 , Maryjane Farr  4 , Scott Silvestry  5 , Joseph G Rogers  6
Affiliations
Free article

A change of heart: Preliminary results of the US 2018 adult heart allocation revision

Rebecca R Goff et al. Am J Transplant. 2020 Oct.
Free article

Abstract

In 2018, the Organ Procurement and Transplantation Network (OPTN) modified adult heart allocation to better stratify candidates and provide broader access to the most medically urgent candidates. We analyzed OPTN data that included waiting list and transplant characteristics, geographical distribution, and early outcomes 1 year before (pre: October 18, 2017-October 17, 2018) and following (post: October 18, 2018-October 17, 2019) implementation. The number of adult heart transplants increased from 2954 pre- to 3032 postimplementation. Seventy-eight percent of transplants in the post era were for the most medically urgent (statuses 1-3) compared to 68% for status 1A in the pre era. The median distance between the donor hospital and transplant center increased from 83 to 216 nautical miles, with an increase in total ischemic time from 3 to 3.4 hours (all P < .001). Waiting list mortality was not different across eras (14.8 vs 14.9 deaths per 100 patient-years pre vs post respectively). Posttransplant patient survival was not different, 93.6% pre and 92.8% post. There is early evidence that the heart allocation policy has enhanced stratification of candidates by their medical urgency and broader distribution for the most medically urgent candidates with minimal impact on overall waiting list mortality and posttransplant outcomes.

Keywords: Organ Procurement and Transplantation Network (OPTN); clinical research/practice; health services and outcomes research; heart disease; heart transplantation/cardiology; organ allocation; organ procurement and allocation; patient survival; statistics.

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References

REFERENCES

    1. OPTN Public Comment Document. Proposal to modify the Adult Heart Allocation System. https://optn.transplant.hrsa.gov/media/1921/thoracic_adult_heart_allocat.... Published August 2016. Accessed March 15, 2020.
    1. OPTN Board Briefing. Proposal to Modify the Adult Heart Allocation December 2016. https://optn.transplant.hrsa.gov/media/2006/thoracic_brief_201612.pdf. Accessed March 15, 2020.
    1. Wever-Pinzon O, Drakos SG, Kfoury AG, et al. Morbidity and mortality in heart transplant candidates supported with mechanical circulatory support: is reappraisal of the current United Network for Organ Sharing Thoracic Organ Allocation Policy justified? Circulation. 2013;127:452-462.
    1. The Organ Procurement and Transplantation Network final rule of 2000, 42 U.S.C. §§ 121. https://www.ecfr.gov/cgi-bin/text-idx?SID=bb60e0a7222f4086a88c31211cac77.... Accessed April 1, 2020.
    1. Dardas T, Mokadam NA, Pagani F, et al. Transplant registrants with implanted left ventricular assist devices have insufficient risk to justify elective organ procurement and transplantation network status 1A time. J Am Coll Cardiol. 2012;60:36-43.

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