New system, old problem: Increased wait time for high-priority transplant candidates

Area of Science:

• Cardiology
• Transplant Surgery
• Public Health Policy

Background:

• The 2018 heart allocation policy aimed to optimize organ distribution and reduce mortality among critically ill patients awaiting transplantation.
• Previous allocation systems faced challenges in effectively stratifying risk and prioritizing the sickest candidates.

Purpose of the Study:

• To evaluate the impact of the 2018 heart allocation policy on wait times for adult, single-organ heart transplant recipients.
• To assess changes in waitlist duration stratified by patient priority status, blood type, and geographic region.

Main Methods:

• Analysis of adult single-organ heart transplant recipients from the United Network for Organ Sharing (UNOS) registry.
• Data collection spanned from October 18, 2018, to July 8, 2022, divided into four post-policy implementation periods.
• Comparison of median and mean wait times based on priority status (Status 1 vs. Status 2), blood type, and UNOS region.

Main Results:

• No significant change in median wait times was observed for Status 1 (highest priority) patients.
• A statistically significant increase of 4.2 days in mean wait time was found for Status 2 patients with each subsequent period post-policy.
• Wait times were longest for blood type O and shortest for blood types AB and A, with regional variations persisting and increasing over time.

Conclusions:

• The 2018 heart allocation policy did not improve wait times for the highest acuity patients (Status 1).
• The policy was associated with a progressive increase in wait times for Status 2 heart transplant candidates.
• Blood type O and regional factors continue to influence heart transplant wait times, necessitating further policy refinement.