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Exploring Physician Perceptions of the 2018 United States Heart Transplant Allocation System
Ersilia M Defilippis1, Mitchell A Psotka2, Prateeti Khazanie3
1Division of Cardiology, Columbia University Irving Medical Center, New York, New York.
Insights
The 2018 US heart transplant allocation system needs changes, according to most heart specialists. Physicians report increased use of mechanical support and concerns about altered practices under the new heart transplant policy.
Area of Science:
- Cardiology
- Transplant Surgery
- Health Policy
Background:
- The 2018 US heart transplant allocation system aimed to optimize organ distribution.
- Clinician experiences and perceptions of this new system remain under-documented.
Purpose of the Study:
- To survey heart failure cardiologists and surgeons regarding the 2018 US heart transplant allocation system.
- To assess physician perspectives on policy changes and goal achievement.
Main Methods:
- A web-based survey was distributed to heart failure cardiologists and surgeons.
- Physician feedback on the 2018 heart allocation policy was collected and analyzed.
Main Results:
- 94% of participants believe the 2018 heart allocation system requires modification.
- 84% reported increased use of temporary mechanical circulatory support to achieve higher transplant status.
- 86% expressed concern regarding changes in physician behavior and practices due to the new system.
Conclusions:
- Key areas for improvement include prioritizing patients on durable left ventricular assist devices.
- Modifications to status criteria, particularly for status 2, and exceptions are suggested.
- Advocacy for a comprehensive heart allocation score is recommended for a more equitable system.
Background:
After the implementation of the 2018 US heart transplant allocation system, the experience and perceptions of heart transplant clinicians have not been well-cataloged.
Methods And Results:
This web-based survey of both heart failure cardiologists and surgeons examined physician perspectives about the policy changes and whether the system is meeting its intended goals. The majority of participants (94%, n = 113) responded that the 2018 heart allocation system requires modification. Eighty-four percent reported using more temporary mechanical circulatory support to achieve higher status and 86% were concerned about the change in physician behavior and practices under the new system.
Conclusions:
Suggestions for possible improvement included higher status for patients on durable left ventricular assist device support, changes to criteria for status 2, modification of status exceptions, and advocacy for a heart allocation score.
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