UNOS policy change benefits high-priority patients without harming those at low priority

Area of Science:

• Cardiology
• Transplantation Medicine
• Health Policy

Background:

• A recent heart transplantation policy change (PC) aimed to improve outcomes for high-acuity patients.
• The impact of this policy change on low-priority heart transplant candidates remained unclear.

Purpose of the Study:

• To assess if the benefits to high-priority patients compromised outcomes for low-priority candidates.
• To evaluate the interaction between the policy change and patient priority status on transplant outcomes.

Main Methods:

• Utilized data from the UNOS registry for adult first-time heart transplant candidates and recipients.
• Analyzed clinical characteristics and performed competing risks and survival analyses.
• Stratified analyses by policy change status and patient priority status.

Main Results:

• An interaction was found between the policy change and priority status regarding waitlist death/deterioration (adjusted sdHR: 0.59).
• Low-priority patients showed a trend towards reduced waitlist death/deterioration (adjusted sdHR: 0.86) and increased heart transplantation (adjusted sdHR: 1.08).
• No significant difference in 1-year post-transplant survival was observed for low-priority patients after the policy change.

Conclusions:

• The heart transplantation policy change did not negatively affect waitlisted or transplanted low-priority patients.
• High-priority patients experienced a targeted reduction in waitlist mortality without compromising post-transplant survival.
• The policy change successfully benefited high-priority patients without adverse consequences for low-priority candidates.