A change of heart: Preliminary results of the US 2018 adult heart allocation revision. Issue 10 (14th June 2020)

• Record Type: Journal Article
• Authors: Goff, Rebecca R.; Uccellini, Kimberly; Lindblad, Kelsi; Hall, Shelley; Davies, Ryan; Farr, Maryjane; Silvestry, Scott; Rogers, Joseph G.
• Is Part Of: American journal of transplantation. Volume 20:Issue 10(2020)
• Page Start: 2781
• Page End: 2790
• Publication Date: 2020-06-14
• Subjects: clinical research/practice -- health services and outcomes research -- heart disease -- heart transplantation/cardiology -- organ allocation -- organ procurement and allocation -- Organ Procurement and Transplantation Network (OPTN) -- patient survival -- statistics; Transplantation of organs, tissues, etc -- Periodicals; 617.95
• DOI: 10.1111/ajt.16010
• Languages: English
• ISSNs: 1600-6135

Abstract

Abstract : In 2018, the Organ Procurement and Transplantation Network (OPTN) modified adult heart allocation to better stratify candidates and provide broader access to the most medically urgent candidates. We analyzed OPTN data that included waiting list and transplant characteristics, geographical distribution, and early outcomes 1 year before (pre: October 18, 2017‐October 17, 2018) and following (post: October 18, 2018‐October 17, 2019) implementation. The number of adult heart transplants increased from 2954 pre‐ to 3032 postimplementation. Seventy‐eight percent of transplants in the post era were for the most medically urgent (statuses 1‐3) compared to 68% for status 1A in the pre era. The median distance between the donor hospital and transplant center increased from 83 to 216 nautical miles, with an increase in total ischemic time from 3 to 3.4 hours (all P < .001). Waiting list mortality was not different across eras (14.8 vs 14.9 deaths per 100 patient‐years pre vs post respectively). Posttransplant patient survival was not different, 93.6% pre and 92.8% post. There is early evidence that the heart allocation policy has enhanced stratification of candidates by their medical urgency and broader distribution for the most medically urgent candidates with minimal impact on overall waiting list mortality and posttransplant outcomes. Abstract : This article compares timeframes before and after implementation of a revised heart allocation policy, showing increased travel distance, more transplants for the most medically urgent, and similar waitlist and posttransplant mortality rates.