Donor Heart Allocation

Abstract

The limited number of donor hearts is one of the greatest and persistent challenges to heart transplantation. Allocation of this precious resource requires the integration of objective data, clinical intuition, and moral fairness. Institution of an allocation system by UNOS has provided important structure to the allocation methodology. The system must be periodically reviewed and reorganized to ensure it is reflective of current patient disease and clinical practice and builds upon the previous knowledge paradigms. Since the establishment of the 2006 allocation system, not only has there been a dramatic increase in the number of heart transplant candidates, but also a dramatic increase in the number of patients qualifying as high-priority candidates. To address these changes, UNOS Thoracic Organ Transplantation Committee was tasked with providing a revised allocation system. The resulting system aims to improve waitlist mortality and posttransplant outcomes by better prioritizing the highest acuity patients while improving the geographic distribution of organ offers.

Cost-Effectiveness of a Small Intrapericardial Centrifugal Left Ventricular Assist Device

“…These changes are expected to result in longer wait times for LVAD patients compared with the previous system. 8 These trends underscore the importance of cost-effectiveness evaluations of LVAD therapy in an era when health care cost is a major focus.…”

Balancing supply and demand: Review of the 2018 donor heart allocation policy

“…6 By 2006, efforts shifted to focus on geographic considerations to improve outcomes for the sickest patients while being cognizant of The number of status 1A patients awaiting organs have grown considerably, accounting for nearly 60% of the waitlist. 12 Waitlist morality in this group is high: nearly three times that of other candidates. 7,8 However, significant ambiguity and heterogeneity exist within status 1A based on the 2006 three-tiered definition.…”

“…12,16 Candidates listed under MCS criteria more than doubled since 2006, representing 24.4% of the waitlist in 2015. 12,17 Technological advances have changed the waitlist profile by allowing older, more medically complex patients to survive to transplant. However, use of MCS devices occurs in a wide spectrum of patients and with corresponding variability in mortality.…”

“…By prioritizing local candidates, lower acuity patients may have received offers before sicker patients located in zone A near the donor hospital but outside the DSA. 12,17 The result being significant regional variability in time spent on the waitlist. Between 2006 and 2012, median waitlist time for status 1A candidates ranged from 50 days in the northeastern states to 8 days in the great plains.…”

“…As such, the new policy may in fact promote the geographic disparities it was designed to eliminate. 12 Further revisions to better match the population density to organ availability may be warranted. 1 Development of a HAS was considered in the early stages of the 2018 policy revisions, but ultimately rejected due to lack of sufficient data and concern for the substantial time investment required for development.…”