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Lung Rapid Recovery Procurement Combined with Abdominal Normothermic Regional Perfusion in Controlled Donation after Circulatory Death

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Characterizing Survival for Patients Supported With Inotropes After the 2018 Donor Allocation Restructuring: A UNOS

Christopher Pritting¹, Joshua Chen², Abdulmojeed Ekiyoyo³

¹Department of Surgery, Bayhealth Medical Center, Dover, Delaware, USA.

Clinical Transplantation

|March 4, 2025

Summary

The 2018 UNOS donor heart allocation policy revision increased temporary support use (ECMO, tMCS, IABP) and improved heart transplant (HTx) survival rates for patients on inotropes. This policy change led to more transplants and better outcomes.

Keywords:

UNOS heart allocation policy inotrope transplant

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Area of Science:

Cardiology
Transplantation Medicine
Public Health Policy

Background:

The 2018 revision of the United Network for Organ Sharing (UNOS) donor heart allocation policy aimed to adapt to changing transplant landscapes.
Understanding the impact of this policy on patient selection and outcomes, particularly for those requiring inotropic support, is crucial.

Purpose of the Study:

To characterize adaptive changes in heart transplant (HTx) candidate management following the 2018 UNOS policy revision.
To estimate long-term survival trends for HTx recipients in relation to inotropic support and mechanical circulatory support devices.

Main Methods:

Retrospective analysis of UNOS database for patients listed for HTx before (July 2014-July 2016) and after (October 2018-October 2020) the policy revision.
Examined trends in device progression (inotropes to ECMO, LVAD, tMCS, IABP) and survival post-transplantation.

Main Results:

The post-policy period saw increased transplantation rates for patients supported with intra-aortic balloon pump (IABP), temporary mechanical circulatory support (tMCS), and extracorporeal membranous oxygenator (ECMO).
Fewer patients were transplanted on inotropes or durable left ventricular assist devices (LVADs) post-policy, with a significant increase in progression from inotropes to other support forms.
Waitlisted patients post-policy had higher transplantation rates (89.8% vs. 78.9%) and improved survival (19.1% mortality vs. 26.9%).

Conclusions:

The 2018 UNOS policy revision shifted utilization towards temporary support devices (ECMO, tMCS, IABP) and away from durable LVADs.
Policy revisions resulted in increased transplantation and improved survival for patients on inotropes.
Survival rates were comparable across different forms of temporary support utilized post-transplantation.