Heart Transplantation Utilizing Brain-Dead Donors Procured From Extended Distances Under the 2018 New Allocation...

Area of Science:

• Cardiology
• Transplant Surgery
• Public Health Policy

Background:

• Limited data exist on the impact of new organ allocation policies on the use of donor hearts from extended distances (ED).
• Understanding outcomes is crucial for optimizing organ utilization and patient survival.

Purpose of the Study:

• To evaluate the effect of a new heart allocation policy implemented on October 18, 2018, on the utilization of donor hearts from ED (greater than 500 miles).
• To compare transplant outcomes between recipients of hearts from ED before and after the policy change.

Main Methods:

• Analysis of the United Network for Organ Sharing database from May 2014 to March 2023.
• Comparison of 1885 isolated heart transplants using donor hearts from ED.
• Propensity score matching was used to create comparable cohorts (N=439 pairs) based on the policy change date.

Main Results:

• Utilization of hearts from ED increased 2.7-fold after the policy change.
• No significant differences were observed in the incidence of dialysis, stroke, or pacemaker implantation between the old and new policy groups in the matched cohort.
• One-year recipient survival (90.9% vs. 90.4%) and graft survival (90.7% vs. 90.2%) were similar in both groups.

Conclusions:

• The new heart allocation policy significantly increased the utilization of donor hearts from extended distances.
• The policy change did not adversely affect short-term transplant outcomes, including recipient and graft survival.
• This suggests successful adaptation to the new policy for utilizing ED donor hearts.