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Geographic Variation Exists in Heart Transplantation for Status One and Two Patients After the 2018 Heart Allocation
Kavya Rajesh1, Mohamed Hassanein2, Sameer Singh1
1Division of Cardiothoracic and Vascular Surgery, New York Presbyterian Hospital, Columbia University Medical Center, New York, New York, USA.
Insights
The 2018 heart transplant policy change did not reduce regional differences in wait times for successful heart transplantation. Significant geographic variations persist, impacting patient access to this life-saving procedure.
Area of Science:
- Transplantation Medicine
- Organ Allocation Policy
- Health Services Research
Background:
- The 2018 heart transplant allocation policy aimed to equalize waiting times across United Network for Organ Sharing (UNOS) regions.
- This study investigates regional disparities in waitlist duration and post-transplant results following the policy update.
Purpose of the Study:
- To assess the impact of the 2018 heart transplant allocation policy on regional variability in waitlist times.
- To examine post-transplant outcomes in relation to geographic region after the policy change.
Main Methods:
- Analysis of adult patients from the United Network for Organ Sharing registry (October 2018–December 2022).
- Evaluation of regional trends in waitlist duration, waitlist events, and post-transplant outcomes.
- Assessment of changes in regional variability of successful transplantation over time.
Main Results:
- 8029 patients were included in the study.
- Significant differences in the cumulative incidence of successful 30-day heart transplantation were observed across regions (p < 0.001).
- No significant differences in 30-day post-transplant mortality were found between regions, but regional disparities in successful transplantation rates persisted annually.
Conclusions:
- The 2018 heart transplant allocation policy has not effectively reduced significant geographic variations in the time to successful transplantation.
- Persistent regional disparities highlight ongoing inequities in access to heart transplants.
Background:
The heart transplant allocation policy change in 2018 was intended to help ameliorate differences in waiting times for heart transplantation across UNOS regions. We sought to examine the regional variability in waitlist times and post-transplant outcomes since these changes were implemented.
Methods:
The adult patients in the United Network for Organ Sharing registry from October 2018 to December 2022 were included. Regional trends in waitlist time, waitlist events, and post-transplant outcomes were assessed. Differences in regional variability of successful transplantation over years since policy change were described.
Results:
A total of 8029 patients were included. The cumulative incidence of successful transplant after 30 days was significantly different across regions (p < 0.001). There was no difference in 30-day post-transplant mortality across regions. In each year since the policy change, there continues to be a significant difference in the lowest and highest cumulative incidence of successful transplant at 30 days across regions using difference of difference analysis, suggesting regional variation has not improved over time (p = 0.49).
Conclusions:
Since the allocation policy change, there continues to be significant variation in time to successful transplantation across geographic regions.
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