Analyzing adult heart allocation policy

Early evidence suggests a new heart allocation policy has achieved many of its intended goals, enhancing stratification of candidates by medical urgency and providing broader distribution for the most medically urgent candidates with minimal impact on overall post‐transplant outcomes, according to United Network for Organ Sharing-led research that recently published in the May issue of the American Journal of Transplantation.

Adult heart allocation has historically been driven by predicted waitlist mortality, and reliant on health care providers to transplant the candidates who they felt would most benefit from the procedure. To address inherent deficiencies of the previous policy, the Organ Procurement and Transplantation Network implemented a new heart allocation policy in 2018. The new six-tiered system modernizes prioritization to better stratify candidates and provide broader access to the most medically urgent cases.

To assess the effectiveness of the new allocation policy, researchers analyzed OPTN data on waitlist and transplant characteristics, geographical distribution, and early outcomes one year before and after the new policy was implemented. The OPTN released a one-year monitoring report in March prior to releasing the full analysis in May.

Key findings included:

• Seventy‐eight percent of transplants in the “post” era were for the most medically urgent (statuses 1‐3) candidates, compared to 68 percent for status 1A in the “pre” era.
• The median distance between the donor and transplant hospital increased from 83 to 216 nautical miles.
• No statistically significant change in six-month post-transplant patient survival (93.6 percent pre vs. 92.8 percent post).

Read the abstract

Goff, R.R., Uccellini, K., Lindblad, K., Hall, S., Davies, R., Farr, M., Silvestry, S. and Rogers, J.G. (2020), A Change of Heart: Preliminary Results of the US 2018 Adult Heart Allocation Revision. Am J Transplant. Accepted Author Manuscript. doi:10.1111/ajt.16010