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The Journal of Heart and Lung Transplantation
International Society for Heart and Lung Transplantation.

A bridge to nowhere: The durable left ventricular assist device dilemma in the new heart allocation system

  • Kevin Chung
    Affiliations
    Pritzker School of Medicine, University of Chicago, Chicago, Illinois
    Search for articles by this author
  • William F. Parker
    Correspondence
    Reprint requests: William F. Parker, MD, PhD, Department of Public Health Sciences, University of Chicago, 5841 S Maryland Avenue, MC 6076, Chicago, IL 60637. Telephone: 773-702-9660. Fax: (773) 702-1000.
    Affiliations
    Pritzker School of Medicine, University of Chicago, Chicago, Illinois

    Department of Public Health Sciences, University of Chicago, Chicago, Illinois

    Department of Medicine, University of Chicago, Chicago, Illinois
    Search for articles by this author
Published:October 28, 2022DOI:https://doi.org/10.1016/j.healun.2022.10.012
      On October 18th, 2018, the Organ Procurement and Transplant Network (OPTN) substantially lowered the priority status of candidates with bridge-to-transplant (BTT) durable left ventricular assist devices (d-LVADs). The new status heart allocation system effectively reduced the priority of d-LVAD candidates by an entire status category; even major complications like pump thrombosis and driveline now garner lower priority than temporary mechanical circulatory support. Unsurprisingly, advanced heart failure programs reacted rapidly to this policy change by listing fewer patients with d-LVADs and more patients with high-priority devices like temporary left ventricular assist devices (t-LVADs), intra-aortic balloon pump (IABP), and extracorporeal membrane oxygenation, using exception requests to get around new hemodynamic requirements.
      • Ran G
      • Chung K
      • Anderson AS
      • et al.
      Between-center variation in high-priority listing status under the new heart allocation policy.
      • Mullan CW
      • Chouairi F
      • Sen S
      • et al.
      Changes in use of left ventricular assist devices as bridge to transplantation with new heart allocation policy.
      • Parker WF
      • Chung K
      • Anderson AS
      • Siegler M
      • Huang ES
      • Churpek MM.
      Practice changes at U.S. transplant centers after the new adult heart allocation policy.
      From 2017 to 2019, the proportion of patients listed for transplant at the time of d-LVADs implantation has fallen from 23.6% to 8.9%, while destination therapy has increased from 49.5% to 73.1%.
      • Molina EJ
      • Shah P
      • Kiernan MS
      • et al.
      The society of thoracic surgeons intermacs 2020 annual report.
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