The impending crisis awaiting cardiac transplantation. Modeling a solution based on selection

Area of Science:

• Cardiology
• Transplant Surgery
• Public Health Policy

Background:

• Monthly addition of transplant candidates exceeds available donor hearts, increasing wait times.
• Many outpatients with deteriorating conditions urgently require transplantation.
• The current heart transplant waiting list comprises 2400 candidates with an 8-month average wait.

Purpose of the Study:

• To model the stabilization of outpatient and critical candidate pools for heart transplantation.
• To predict the impact of altered candidate listing policies on waiting list size and outcomes.
• To identify strategies for minimizing deaths and optimizing heart allocation.

Main Methods:

• Population models were constructed using statistics on donor hearts, candidate listing, sudden death, and patient decline.
• Models were revised to simulate the effects of policy changes, such as age limits and risk stratification.
• Predicted outcomes were analyzed over a 48-month period.

Main Results:

• Without policy changes, the list will stabilize at 270 hospitalized and 3700 outpatient candidates, with limited transplant chances for the latter.
• Reducing the upper age limit to 55 would decrease monthly listings by 30%, stabilizing the list at 1490 candidates.
• Listing only candidates with an 80% risk of deterioration would reduce the list by 30%, stabilizing it at one-third its current size, with improved outpatient access.

Conclusions:

• Immediate measures are needed to limit candidate listing and manage expectations for outpatient transplant likelihood.
• Future efforts should prioritize selecting candidates at the highest risk of deterioration without transplantation.
• Rigorous candidate selection can minimize overall deaths and improve heart allocation efficiency.