An early investigation of outcomes with the new 2018 donor heart allocation system in the United States

True, true, and possibly unrelated: Variability in donor heart acceptance practices across the United States

“…Three priority statuses have been expanded to six, and there is no longer a local allocation priority. The first zone of allocation is 500 nautical miles from the donor hospital, which has invariably increased average ischemic time from a mean of 3‐3.4 hours 10 . Similar to the findings in this analysis by Khush and Ball, Cogswell et al noted that each 30‐minute increase in ischemic time in the new allocation system has been associated with an 8% increase in the risk of posttransplant death or retransplantation 10 .…”

“…The first zone of allocation is 500 nautical miles from the donor hospital, which has invariably increased average ischemic time from a mean of 3‐3.4 hours 10 . Similar to the findings in this analysis by Khush and Ball, Cogswell et al noted that each 30‐minute increase in ischemic time in the new allocation system has been associated with an 8% increase in the risk of posttransplant death or retransplantation 10 . Khush and Ball also noted multiple recipient characteristics that are most predictive of 30‐day and 1‐year mortality and retransplantation.…”

“…However, the current revised allocation system is prioritizing the illness of the recipient over all other variables. There has never been a change in heart allocation in the United States that has led to a significant increase in posttransplant mortality until now 10 . If persistent, this increase in posttransplant mortality may actually make transplant cardiologists and surgeons less likely to consider liberalizing their donor acceptance criteria.…”

Temporary left ventricular assist devices as a bridge to heart transplantation

“…The combination of the recent prioritization of patients on TMCS and reports of ECMO bridge-to-transplantation (BTT) mortality exceeding 30% at 1-year follow-up has made surgically implanted T-LVADs with and without T-RVADs an attractive clinical option for BTT patients. 1,3,6 The risk of mortality and device-related complications in patients on prolonged T-LVADs is exceedingly high necessitating either cardiac recovery, durable CF-LVAD implantation or OHT to avoid mortality. 8,9 The current evidence describing the outcomes following a direct bridge from T-LVADs to OHT is limited to small cohorts that include a variety of TMCS devices.…”

“…4,5 To create equitable access to donor organs for the highest mortality patients, the Organ Procurement and Transplantation Network in association with the United Network for Organ Sharing (UNOS) updated the cardiac transplant allocation system in October 2018. 6 Under the new policy, patients with surgically implanted biventricular support receive the highest priority status supported with a CF-LVAD or T-LVAD. The study excluded patients who underwent heterotopic transplants, multiorgan transplants, isolated right ventricular assist devices and patients bridged with nonstudy devices including extracorporeal membrane oxygenation (ECMO), total artificial heart or alternative durable or TMCS device types.…”