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AJT article analyzes adult heart allocation policy

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In an article published online by the American Journal of Transplantation, early evidence suggests  that the modified adult heart allocation policy approved in 2018 has enhanced stratification of candidates by medical urgency and provided broader geographic distribution for the most medically urgent candidates, with minimal impact on overall waitlist mortality and post‐transplant outcomes.

The OPTN modified the policy to better stratify candidates and provide broader access to the most medically urgent candidates. Adult heart allocation has historically been driven by predicted waitlist mortality, and it relies primarily on the clinical judgement of transplant physicians to select transplant candidates most likely to have successful post-transplant outcomes.

To address inherent deficiencies of the previous policy, the OPTN implemented a modified heart allocation policy in 2018. The new six-tiered system modernizes prioritization to better stratify candidates and provide broader access to the most medically urgent cases.   

To assess the effectiveness of the modified allocation policy, the researcher team analyzed OPTN data on waitlist and transplant characteristics, geographical distribution, and early outcomes one year before and after the new policy was implemented.

Key findings included:

  •        Seventy‐eight percent of transplants in the “post” era were for the most medically urgent (status 1‐3) candidates, compared to 68 percent for status 1A in the “pre” era.
  •        The median distance between the donor and transplant hospital increased from 83 to 216 nautical miles (95 to 216 common statue miles)
  •        No statistically significant change in six-month post-transplant patient survival (93.6 percent pre vs. 92.8 percent post)

Read the abstract

Goff, R.R., Uccellini, K., Lindblad, K., Hall, S., Davies, R., Farr, M., Silvestry, S. and Rogers, J.G. (2020), A Change of Heart: Preliminary Results of the US 2018 Adult Heart Allocation Revision. Am J Transplant. Accepted Author Manuscript. doi:10.1111/ajt.16010