Between-center variation in high-priority listing status under the new heart allocation policy

Area of Science:

• Cardiology
• Transplant Surgery
• Health Policy

Background:

• The revised US heart allocation policy aimed to optimize organ distribution.
• An increase in high-priority listings for patients with mechanical circulatory support devices was observed post-policy.

Purpose of the Study:

• To assess if the rise in high-priority listings was widespread or concentrated among specific transplant centers.
• To analyze changes in transplant center practices following the new heart allocation policy.

Main Methods:

• Utilized data from the Scientific Registry of Transplant Recipients.
• Employed mixed-effect logistic regression to compare pre-policy and post-policy adult heart-alone transplant candidate listings.
• Analyzed listings from December 2016 to February 2018 (pre-policy) and December 2018 to February 2020 (post-policy).

Main Results:

• Nearly all US transplant centers (94.8%) listed more candidates at high-priority status post-policy.
• The proportion of high-priority listings increased significantly from 7.0% to 25.5% (p < .001).
• Centers in Organ Procurement Organizations with higher pre-policy Status 1A transplant rates were more likely to use high-priority status.

Conclusions:

• The new heart allocation policy prompted widespread and variable changes in transplant center listing practices.
• These practice shifts may potentially undermine the intended effectiveness of the new heart allocation system.
• Further evaluation is needed to understand the long-term impact on organ allocation and patient outcomes.