Executive Summary

The Thoracic Organ Transplantation Committee (the Committee) proposes modifications to the adult heart allocation system to better stratify the most medically urgent heart transplant candidates, reflect the increased use of mechanical circulatory support devices (MCSD) and prevalence of MCSD complications, and address geographic disparities in access to donors among heart transplant candidates. Though changes to the adult heart allocation system implemented in 2006 were successful, candidates with disparate waiting list mortalities are currently grouped together in the most urgent classification, status 1A, causing waiting time to be the primary factor in stratifying candidates. Additionally, the current geographic sharing scheme creates potential inequities in access to transplant for the most urgent candidates.

The Committee proposes two significant changes to the adult heart allocation system:

1. Develop additional urgency stratifications based on relative waiting list mortality rates for all adult heart candidates

2. Modify the geographic sharing scheme to provide the most medically urgent candidates access to donors from a broader geographic area

The Committee’s proposal is supported by modeling analysis performed by the Scientific Registry of Transplant Recipients (SRTR). The proposed changes are expected to lower waiting list morality rates overall and achieve higher transplant rates for the most medically urgent candidates without increasing overall post-transplant mortality rates or increasing waiting list mortality rates for candidates in lower urgency statuses.

Read the full proposal.

• Part 1
• Part 2