Related Experiment Video
Updated: Nov 8, 2025
A Pre-Clinical Porcine Model of Orthotopic Heart Transplantation
Published on: April 27, 2019
Allocation changes in heart transplantation: What has really changed?
Asvin M Ganapathi1, Brent C Lampert2, Nahush A Mokadam1
1Division of Cardiac Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
Insights
The 2018 heart transplant allocation change increased temporary mechanical circulatory support use and travel distance, but did not alter transplant volumes. Further study is needed to assess long-term outcomes under the new system.
Area of Science:
- Cardiology
- Transplant Surgery
- Public Health Policy
Background:
- The 2018 heart allocation system revision aimed to improve equity and efficiency.
- Key changes included revised status classifications and expanded geographic distribution for heart transplants.
Purpose of the Study:
- To evaluate the immediate impact of the 2018 heart allocation system changes on national transplant practices.
- To analyze shifts in temporary mechanical circulatory support use, waitlist times, travel distance, and ischemic times.
Main Methods:
- Utilized the Scientific Registry of Transplant Recipients database for adult primary, isolated heart transplants.
- Compared data from the pre-allocation change period (Oct 2017-Oct 2018) with the post-allocation change period (Oct 2018-Oct 2019).
- Conducted unadjusted and multivariable logistic regression analyses, including volume analysis at regional, state, and center levels.
Main Results:
- A significant increase in temporary mechanical circulatory support use (11.1% to 36.2%) and a decrease in waitlist days (93 to 41) were observed post-change.
- Increased travel distance (83 to 225 nautical miles) and ischemic time (3.0 to 3.4 hours) were also noted.
- The post-allocation period was independently associated with temporary mechanical circulatory support use (OR, 4.463; P < .001).
- No significant changes in transplant volumes at regional, state, or center levels were found.
Conclusions:
- The 2018 heart allocation system changes led to increased use of temporary mechanical circulatory support and longer travel/ischemic times.
- Transplant volumes remained stable nationally and regionally despite the allocation system modifications.
- Ongoing monitoring of patient outcomes and transplant volumes under the new allocation system is crucial.
Objective:
In 2018, the heart allocation system changed status classifications and broadened geographic distribution. We examined this change at a national level based on the immediate pre- and postchange periods.
Methods:
Using the Scientific Registry of Transplant Recipients database, we identified all adult primary, isolated heart transplants from October 18, 2017, to October 17, 2019. Two time periods were compared: (1) October 18, 2017, to October 17, 2018 (pre); and (2) October 18, 2018, to October 17, 2019 (post). Comparisons were made between groups, and a multivariable logistic regression model was created to identify factors associated with pretransplant temporary mechanical circulatory support. Volume analysis at the regional, state, and center level was also conducted as the primary focus.
Results:
A total of 5381 independent heart transplants were identified within the time frame. On unadjusted analysis, there was a significant increase in temporary mechanical circulatory support (pre, 11.1%; post, 36.2%, P < .01) and decrease in waitlist days (pre, 93 days; post, 41 days; P < .01). Distance traveled (nautical miles) (pre, 83; post, 225; P < .01) and ischemic time (hours) (pre, 3.0; post, 3.4; P < .01) were significantly increased. On multivariable analysis, the postallocation time period was independently associated with temporary MCS (odds ratio, 4.463; 95% confidence interval, 3.844-5.183; P < .001). Transplant volumes did not significantly change after the allocation change at a regional, state, and center level.
Conclusions:
Since the planned alteration to the allocation system, there have been changes in the use of temporary mechanical circulatory support as well as distance and ischemic time associated with transplant, but no significant volume changes were observed. Continued observation of outcomes and volume under the new allocation system will be necessary in the upcoming years.
