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Review of the allocation criteria for heart transplant in Spain in 2023. SEC-Heart Failure Association/ONT/SECCE
José González-Costello1, Alicia Pérez-Blanco2, Juan Delgado-Jiménez3
1Servicio de Cardiología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Departamento de Ciencias Clínicas, Facultad de Medicina, Universitat de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Spain.
Insights
New heart transplant (HT) allocation criteria in Spain were developed to ensure fair access and prioritize patients with advanced heart failure (HF). This involved a multidisciplinary review of current practices and international models.
Area of Science:
- Cardiology
- Transplantation Medicine
- Public Health Policy
Background:
- Heart transplantation (HT) is the optimal treatment for end-stage heart failure (HF).
- Current allocation criteria aim for equitable access and prioritize critically ill patients.
- Spain's National Transplant Organization (ONT) and cardiology societies convened to reassess these criteria.
Purpose of the Study:
- To analyze the management of advanced HF and cardiogenic shock in Spain.
- To critically evaluate international heart allocation and priority systems.
- To propose updated heart allocation criteria for Spain based on evidence and expert consensus.
Main Methods:
- A consensus conference was organized by the Heart Failure Association of the Spanish Society of Cardiology (HFA-SEC), SECCE, and ONT.
- Participants included cardiologists, cardiac surgeons, transplant coordinators, and ONT physicians/nurses.
- Data analyzed included patient outcomes before and after 2017 criterion modifications and international practices.
Main Results:
- Analysis of patient outcomes pre- and post-2017 HT allocation criteria modification.
- Review of international heart allocation systems and their effectiveness.
- Identification of key factors influencing patient outcomes in advanced HF.
Conclusions:
- The consensus conference provided a comprehensive analysis of Spain's HT allocation system.
- New evidence-based criteria were proposed to optimize equitable access and patient prioritization.
- The findings will guide future heart allocation policies in Spain.
Abstract:
Heart transplant (HT) remains the best therapeutic option for patients with advanced heart failure (HF). The allocation criteria aim to guarantee equitable access to HT and prioritize patients with a worse clinical status. To review the HT allocation criteria, the Heart Failure Association of the Spanish Society of Cardiology (HFA-SEC), the Spanish Society of Cardiovascular and Endovascular Surgery (SECCE) and the National Transplant Organization (ONT), organized a consensus conference involving adult and pediatric cardiologists, adult and pediatric cardiac surgeons, transplant coordinators from all over Spain, and physicians and nurses from the ONT. The aims of the consensus conference were as follows: a) to analyze the organization and management of patients with advanced HF and cardiogenic shock in Spain; b) to critically review heart allocation and priority criteria in other transplant organizations; c) to analyze the outcomes of patients listed and transplanted before and after the modification of the heart allocation criteria in 2017; and d) to propose new heart allocation criteria in Spain after an analysis of the available evidence and multidisciplinary discussion. In this article, by the HFA-SEC, SECCE and the ONT we present the results of the analysis performed in the consensus conference and the rationale for the new heart allocation criteria in Spain.
