Continuing refinement of adult heart allocation policy has significantly reduced the number of candidates who have died awaiting a heart transplant over the last several years without negatively affecting post-transplant survival. However, additional modification may further improve patient access and address ongoing evolution in the medical treatment of heart transplant candidates.
In the January 2015 issue of the American Journal of Transplantation, members of the Heart Subcommittee of the OPTN/UNOS Thoracic Organ Transplantation Committee and UNOS researchers describe the status of the committee’s efforts to identify further policy improvements. As part of this process, the subcommittee has sought input from clinicians and researchers nationwide, including participation in a public forum held in November 2013. The authors summarize topics identified for further study, including:
- The structure of the current medical urgency designations and their limitations
- The need for status exceptions to address unique clinical issues for some candidates
- The status of heart transplant candidates who have ventricular assistance devices (VADs)
- Options to improve the geographic distribution of heart offers
- Options to define and prioritize heart candidates with high immune sensitivity
The Scientific Registry of Transplant Recipients (SRTR) is currently performing simulation modeling to analyze the potential impact of various policy options the Thoracic Committee has developed to address these areas of interest. The Thoracic Committee intends to develop and circulate a public comment proposal to improve the effectiveness and equity of the heart allocation system.
NOTE: This study was supported in part by Health Resources and Services Administration contract 234-2005-37011C. The content is the responsibility of the authors alone and does not necessarily reflect the views or policies of the Department of Health and Human Services.
For more detailed information, please consult the articles (UNOS staff members identified with an asterisk):
D.M. Meyer, J.G. Rogers, L.B. Edwards*, E. R. Callahan*, S.A. Webber, M.R. Johnson, J.D. Vega, M.J. Zucker, J.C. Cleveland Jr. and M.L. Barr. The Future Direction of the Adult Heart Allocation System in the United States. American Journal of Transplantation, Vol. 15, Issue 1, January 2015, pp. 44-54.