Related Experiment Video
Updated: Jul 25, 2026
Rat Heterotopic Abdominal Heart/Single-lung Transplantation in a Volume-loaded Configuration
Published on: May 29, 2015
Revised Heart Allocation Policy Improved Waitlist Mortality and Waiting Time With Maintained Outcomes in En-Bloc
Yasuhiro Shudo1, Hao He1, Stefan Elde1
1Stanford Healthcare, Stanford, CA, United States.
Insights
The 2018 heart allocation policy update improved en-bloc heart-lung transplants. Patients experienced higher transplant rates, shorter wait times, and less waitlist mortality, with similar survival post-transplant.
Area of Science:
- Cardiology
- Transplant Surgery
- Public Health Policy
Background:
- The United Network for Organ Sharing (UNOS) revised its heart allocation policy in October 2018.
- En-bloc heart-lung transplantation is a critical procedure for end-stage cardiopulmonary disease.
Purpose of the Study:
- To evaluate the impact of the revised UNOS heart allocation policy on en-bloc heart-lung transplantation outcomes.
- To compare transplant rates, waitlist mortality, and waiting times before and after the policy change.
Main Methods:
- Analysis of a national transplant database.
- Comparison of adult patients listed for en-bloc heart-lung transplants in pre- and post-policy implementation periods.
- Evaluation of transplant rates, waitlist mortality, waiting times, life support utilization, ischemic times, transport distances, and short-term survival.
Main Results:
- The post-policy period showed significantly higher transplant rates, shorter waiting times, and reduced waitlist mortality.
- Increased utilization of life support (intra-aortic balloon pumps, ECMO, VADs) was observed in the post-period.
- Transplant recipients in the post-period had longer ischemic times and transport distances but shorter waiting times.
- Short-term survival rates were similar between the pre- and post-policy periods (p = 0.4357).
Conclusions:
- The revised UNOS heart allocation policy significantly enhanced access to en-bloc heart-lung allografts.
- The policy led to improved waitlist outcomes, including reduced mortality and shorter waiting times.
- Post-transplant outcomes remained comparable, indicating a successful policy revision.
Abstract:
The revised United Network for Organ Sharing heart allocation policy was implemented in October 2018. Using a national transplant database, this study evaluated the transplant rate, waitlist mortality, waiting time, and other outcomes of en-bloc heart-lung transplantation recipients. Adult patients registered on the national database for heart-lung transplants before and after the policy update were selected as cohorts. Baseline characteristics, transplant rates, waitlist mortality, waiting times, and other outcomes were compared between the two periods. In total, 370 patients were registered for heart-lung transplants during the pre- and post-periods. There were significantly higher transplant rates, shorter waitlist times, and substantially reduced waitlist mortality in the post-period. Registered patients waitlisted in the post-period had significantly higher utilization of intra-aortic balloon pumps, extracorporeal membrane oxygenation, and overall life support, including ventricular assist devices. Transplant recipients had significantly longer ischemic times, increased transport distances, and shorter waiting times before transplantation in the post-policy period. Transplant recipients held similar short-term survival before and after the policy change (log-rank test, p = 0.4357). Therefore, the revised policy significantly improved access to en-bloc heart-lung allografts compared with the prior policy, with better waitlist outcomes and similar post-transplant outcomes.
