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Review
. 2023 May;11(5):491-503.
doi: 10.1016/j.jchf.2023.01.009. Epub 2023 Mar 1.

Impact of the 2018 UNOS Heart Transplant Policy Changes on Patient Outcomes

Neil S Maitra  1 , Samuel J Dugger  1 , Isabel C Balachandran  2 , Andrew B Civitello  2 , Prateeti Khazanie  3 , Joseph G Rogers  4
Affiliations
Review

Impact of the 2018 UNOS Heart Transplant Policy Changes on Patient Outcomes

Neil S Maitra et al. JACC Heart Fail. 2023 May.

Abstract

In 2018, the United Network for Organ Sharing implemented a 6-tier allocation policy to replace the prior 3-tier system. Given increasing listings of critically ill candidates for heart transplantation and lengthening waitlist times, the new policy aimed to better stratify candidates by waitlist mortality, shorten waiting times for high priority candidates, add objective criteria for common cardiac conditions, and further broaden sharing of donor hearts. There have been significant shifts in cardiac transplantation practices and patient outcomes following the implementation of the new policy, including changes in listing practices, waitlist time and mortality, transplant donor characteristics, post-transplantation outcomes, and mechanical circulatory support use. This review aims to highlight emerging trends in United States heart transplantation practice and outcomes following the implementation of the 2018 United Network for Organ Sharing heart allocation policy and to address areas for future modification.

Keywords: 2018 allocation policy; United Network for Organ Sharing; heart transplant; outcome.

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Conflict of interest statement

Funding Support and Author Disclosures Dr Khazanie has received research grant support from National Institutes of Health (K23 HL145122) and the University of Colorado Ludeman Center for Women’s Health Research outside of this work. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

FIGURE 1
FIGURE 1. New Criteria for Highest Urgency Listings
Flowchart depicting the new, specified criteria regarding cardiogenic shock, life-threatening ventricular arrhythmia, and mechanical circulatory support (MCS) complication qualifying for high-urgency listing. ALT = alanine transaminase; AST = aspartate transaminase; BiV = biventricular; CI = cardiac index; CPR = cardiopulmonary resuscitation; ECMO = extracorporeal membrane oxygenation; K = potassium; MAP = mean arterial pressure; Mg = magnesium; PCWP = pulmonary capillary wedge pressure; SBP = systolic blood pressure; SvO2 = mixed venous oxygen saturation; VF = ventricular fibrillation; VT = ventricular tachycardia.
FIGURE 2
FIGURE 2. Changes Observed Following Implementation of the 2018 UNOS Heart Transplant Policy
Diagram summarizing overall trends and changes observed after implementation of the 2018 UNOS heart transplant allocation policy. BTT = bridge to transplantation; HT = heart transplantation; IABP = intra-aortic balloon pump; ICU = intensive care unit; LVAD = left ventricular assist device; UNOS = United Network for Organ Sharing; other abbreviations as in Figure 1.
See this image and copyright information in PMC

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