The New US Heart Allocation Scheme: Impact on Waitlist and Post-Transplant Survival
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THORACIC TRANSPLANTATION (J PATEL AND AM HOLM, SECTION EDITORS)
The New US Heart Allocation Scheme: Impact on Waitlist and Post-Transplant Survival Melissa A. Lyle 1
&
J. David Vega 2
Accepted: 7 October 2020 # Springer Nature Switzerland AG 2020
Abstract Purpose of Review In October 2018, the Organ Procurement and Transplantation Network (OPTN) revised the donor heart allocation system in an attempt to prioritize those patients with highest clinical urgency, reduce waitlist morality, and improve geographic equity in organ allocation. Our goal was to review the changes in the heart allocation policy and its impact on transplant characteristics and outcomes. Recent Findings After the new 2018 donor heart allocation system became effective, there has been a trend toward increased use of temporary mechanical circulatory support. Also, initial reports suggested reduced post-transplant survival, although the initial analysis was limited by short follow-up and small sample size. Recent reports however illustrate survival outcomes similar to those of the previous allocation system. Summary The new donor heart allocation policy has been associated with a change in management strategies for bridging patients to transplantation, with increased utilization of temporary mechanical circulatory support, with still uncertain effects on post-transplant survival. Keywords Heart transplantation . Donor . Allocation scheme . Waitlist mortality . Temporary mechanical circulatory support
Introduction Although the heart donor pool has recently expanded with the increased utilization of Public Health Service (PHS) increased-risk donors and hepatitis C virus (HCV)–positive donors [1], there is still a supply-demand mismatch between the number of patients with end-stage heart failure awaiting transplantation and donor availability [2]. The United States (US) donor heart allocation policy previously stratified patients waiting for orthotopic heart transplantation (OHT) by a 3-tiered system (status 1A, 1B, and 2), a system that was maintained by the United Network of Organ Sharing (UNOS) and originally implemented in This article is part of the Topical Collection on Thoracic Transplantation * Melissa A. Lyle [email protected] 1
Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
2
Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
1999. Status 1A, the status representing highest urgency, included patients in cardiogenic shock hospitalized in the intensive care unit with continuous intravenous inotropes or temporary mechanical support in addition to patients with complications from a durable left ventricular assist device (LVAD). Status 1B was designated for patients at home on inotropic support or stable with a LVAD. Status 2 included patients stable on oral regimens and those with congenital heart disease or restrictive cardiomyopathies. The UNOS heart allocation policy was revised in 2006 to allow for regional donor sha
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