Critically appraising the 2018 United Network for Organ Sharing donor allocation policy: adding life boats or...

Area of Science:

• Cardiology
• Transplantation Medicine
• Public Health Policy

Background:

• Growing disparity between donor heart supply and demand.
• Unacceptably high mortality rates among patients on the heart transplant waitlist.
• Need for a revised organ allocation system to improve patient outcomes.

Purpose of the Study:

• To review the changes implemented in the October 2018 heart organ allocation system.
• To analyze the impact of the new system on heart transplant practices.
• To evaluate the effect of the revised policy on heart transplant outcomes in the U.S.

Main Methods:

• Review of the 6-tiered policy of the 2018 heart allocation system.
• Analysis of patient prioritization based on medical support (temporary mechanical circulatory support, durable left ventricular assist devices).
• Assessment of changes in geographic sharing and donor ischemic times.

Main Results:

• Prioritization of the sickest patients, increasing utilization of temporary mechanical circulatory support.
• Decreased utilization of durable left ventricular assist devices.
• Prolonged donor ischemic times due to broader geographic sharing.
• Significant reductions in waitlist mortality and waitlist times.
• Higher incidence of heart transplantation.

Conclusions:

• The United Network for Organ Sharing (UNOS) 2018 allocation policy offers substantial benefits over the previous system.
• The new policy effectively decreases waitlist times and improves waitlist mortality.
• No major adverse impact on post-transplant survival was observed.