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Potential Impact of the OPTN Status Escalation Policy for Adult Heart Transplant Candidates With Durable LVADs

Daniel J Ahn1,2,3, Antony Attia1,2, Toshihiro Nakayama1,2

  • 1Department of Surgery (D.J.A., A.A., T.N., K.S.), Stanford University, CA.

Circulation. Heart Failure
|June 23, 2026
PubMed

Insights

Most durable left ventricular assist device (LVAD) patients either experience complications or receive a transplant within six years. The new Organ Procurement and Transplantation Network (OPTN) policy may not prevent complications before status upgrades and will affect few patients.

Area of Science:

  • Cardiology
  • Transplantation Medicine
  • Biomedical Engineering

Background:

  • The 2018 heart allocation policy change reduced priority for durable left ventricular assist device (LVAD) patients.
  • New Organ Procurement and Transplantation Network (OPTN) policy aims to expedite transplantation for stable LVAD patients.

Purpose of the Study:

  • To evaluate the impact of the 2018 policy change on heart transplant candidates with durable LVADs.
  • To assess the incidence of LVAD-related complications and transplantation rates.
  • To determine the potential effect of the upcoming OPTN policy on waitlist status distribution.

Main Methods:

  • Analysis of Organ Procurement and Transplantation Network (OPTN) data for adult heart transplant candidates with durable LVADs (October 2018 - May 2025).
  • Estimation of cumulative incidence of LVAD complications, with transplantation and waitlist removal as competing events.
  • Assessment of the impact of the proposed OPTN policy change on waitlist status.

Main Results:

  • 4967 adult patients received a durable LVAD.
  • At 6 years post-implantation, cumulative incidence of complications was 42.1%, and transplantation was 36.0%.
  • Only 1.2% remained on the waitlist by 6 years; the new policy would have instantaneously changed statuses for only 4.7% of the waitlist.

Conclusions:

  • Nearly all durable LVAD candidates either experience complications, status upgrades, or are removed from the waitlist within 6 years.
  • The upcoming OPTN policy is unlikely to prevent device complications before status upgrades.
  • The policy is expected to impact a small percentage of durable LVAD candidates.
Abstract

Keywords:
heart transplantationheart-assist devicespolicy

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