The report notes several important trends since implementation, including:
- Policy changes were successful in creating medical urgency statuses that prioritize candidates according to their risk of death while waiting for a transplant.
- Median time spent waiting before a transplant has been reduced substantially, from 242 days pre-policy to 78 days post-policy, a 68% decrease.
- Transplant rates have increased from 78 transplants per 100 patient-years waiting pre-policy to 101 transplants per 100 patient-years post-policy. Increases in transplant rate were most dramatic for the most medically urgent candidates. Post-transplant outcomes have remained constant.
The policy changes were proposed by the former Organ Procurement and Transplantation Network (OPTN) Thoracic Organ Transplantation Committee, which has since split into the Heart Transplantation Committee and the Lung Transplantation Committee. The OPTN Board of Directors approved the adult heart policy modifications in 2016. The OPTN Heart Transplantation Committee will continue to monitor this policy as data is submitted, and subsequent monitoring reports will be published on the OPTN website on an ongoing basis.
The future state of heart allocation
In 2019, the OPTN began working on a single organ allocation framework that could be adapted to all organ types. This approach, called continuous distribution, is a points-based system predicted to increase equity among potential recipients. Lung will be the first organ type to adopt continuous distribution (expected early 2023), and kidney and pancreas are currently moving through a series of steps as the framework is developed for their organ types. Liver and Heart organ types are expected to follow consecutively.