National Organ Procurement and Transplant Network Heart Allocation Policy: 6 Years Later

Area of Science:

• Transplantation Medicine
• Health Policy
• Cardiology

Background:

• The Organ Procurement and Transplant Network (OPTN) reappraised the US heart transplant allocation policy in 2014 due to organ scarcity and high waitlist mortality.
• A redesigned 6-tiered algorithm was implemented in 2018, incorporating device complications and expanding sharing criteria.

Purpose of the Study:

• To critically evaluate the effectiveness and impact of the 2018 US heart transplant allocation policy six years after its implementation.
• To analyze changes in patient prioritization, technology integration, and regulatory oversight within the OPTN framework.

Main Methods:

• Review of historical heart allocation policies in the United States.
• Analysis of the current and evolving candidate prioritization algorithms, including continuous distribution.
• Assessment of the impact of technological innovations on transplant rates and future policy development.

Main Results:

• Significant increase in temporary mechanical circulatory support use among waitlisted candidates.
• Concomitant decrease in durable left ventricular assist device (LVAD) bridging to transplant.
• Rising number of exception requests, particularly for status 2 patients and multiorgan transplants.
• Fewer patients delisted for clinical improvement, suggesting missed recovery opportunities.

Conclusions:

• The 2018 policy has shifted support strategies, but challenges with exception requests and patient recovery persist.
• Ongoing evaluation and adaptation of the heart allocation system are crucial to address evolving needs and optimize outcomes.
• Future policy development must consider technological advancements and regulatory changes to improve organ allocation efficiency and equity.