The United Network for Organ Sharing (UNOS) implemented a revised donor heart allocation
system on October 18, 2018 with principle aims to reduce waitlist mortality, enhance
geographic organ sharing, and improve organ distribution equity. Five recently published
analyses compared outcomes of heart transplant (HT) recipients transplanted under
the revised versus previous system. All demonstrated increased pre-transplant temporary
mechanical circulatory support use and graft ischemic times under the revised system.
However, despite using data from the same UNOS Registry, three analyses demonstrated
increased risk of post-transplant mortality under the revised system, while two others
found no significant difference in mortality risk. These studies differed in their
analytic cohorts, study periods, follow-up duration, and statistical methodologies.
Additionally, some may have introduced survivor bias or violated non-informative censoring.
Given these variable findings, longer-term outcome assessment is warranted before
the HT community can truly understand the impact of the 2018 UNOS system revision
on post-transplant outcomes.
KEYWORDS
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The Journal of Heart and Lung TransplantationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
U.S. Department of Health and Human Services. Organ Procurement and Transplantation Network: adult heart allocation. Available at:https://optn.transplant.hrsa.gov/learn/professional-education/adult-heart-allocation/.
- An early investigation of outcomes with the new 2018 donor heart allocation system in the United States.J Heart Lung Transplant. 2020; 39: 1-4
- Reassessing recipient mortality under the new heart allocation system: an updated UNOS Registry analysis.JACC Heart Fail. 2020; 8: 548-556
- Outcomes of the first 1300 adult heart transplants in the United States after the allocation policy change.Circulation. 2020; 141: 1662-1664
Goff RR, Uccellini K, Lindblad K, et al. A change of heart: preliminary results of the US 2018 adult heart allocation revision [e-pub ahead of print]. Am J Transplant doi:10.1111/ajt.16010, accessed May 22, 2020.
- “Unintended” consequences of changes in heart transplant allocation policy: impact on practice patterns.ASAIO J. 2020; 66: 125-127
- Pump thrombosis redux.J Heart Lung Transplant. 2015; 34: 1511-1514
- Survival probabilities (the Kaplan-Meier method).BMJ. 1998; 317: 1572
- Is it too early to investigate survival outcomes of the new US heart allocation system?.J Heart Lung Transplant. 2020; 39: 726
- Update to an early investigation of outcomes with the new 2018 donor heart allocation system in the United States.J Heart Lung Transplant. 2020; 39: 725-726
- Impact of heart transplantation on survival in patients on venoarterial extracorporeal membrane oxygenation at listing in France.Transplantation. 2016; 100: 1979-1987
- Favorable outcomes of a direct heart transplantation strategy in selected patients on extracorporeal membrane oxygenation support.Crit Care Med. 2020; 48: 498-506
- Practice changes at U.S. transplant centers after the new adult heart allocation policy.J Am Coll Cardiol. 2020; 75: 2906-2916
- Use of temporary mechanical circulatory support for management of cardiogenic shock before and after the United Network for Organ Sharing Donor Heart Allocation System changes.JAMA Cardiol. 2020; 5: 1-6
Article info
Publication history
Published online: August 25, 2020
Identification
Copyright
© 2020 International Society for Heart and Lung Transplantation. All rights reserved.
