Geographic Variation Exists in Heart Transplantation for Status One and Two Patients After the 2018 Heart Allocation...

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.