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

Newton's laws of heart transplant allocation

  • Amrut V. Ambardekar
    Reprint requests: Amrut V. Ambardekar, MD, Department of Medicine, Division of Cardiology, Consortium for Fibrosis Research & Translation, University of Colorado Anschutz Medical Campus, 12700 E. 19th Avenue, Campus Box B-139, Aurora, CO 80045. Telephone: 303-724-6400. Fax: 303-724-2094..
    Department of Medicine, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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  • Jordan R.H. Hoffman
    Department of Surgery, Division of Cardiothoracic Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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Published:November 08, 2022DOI:
      In 1687, Isaac Newton described 3 laws to explain the motion of objects and systems of motion in his Philosophiae Naturalis Principia Mathematica (Mathematical Principals of Natural Philosophy). Over 300 years later, not only are these laws of motion the foundation of classical physics, but they can likewise apply to donor heart allocation. In 1984, the National Organ Transplant Act was passed to ensure the fair and equitable allocation of organs, leading to the establishment of the Organ Procurement and Transplantation Network (OPTN). In 1986, OPTN contracted with the private nonprofit organization United Network for Organ Sharing (UNOS) to formalize an allocation system to prioritize patients based on disease severity and time on a national waitlist, and in 1988, the first 2-tiered heart allocation system was implemented. With the advent of durable left ventricular assist devices (LVADs), a 3-tiered system was implemented in 1998 (status 1A (highest priority), status 1B (intermediate priority), and status 2 (low priority)) again aimed to reduce waitlist time and mortality for the sickest patients. Finally, in 2005, broader geographic sharing rules were implemented to further reduce the waitlist time among the most critically ill, but the original 3-tiers remained unchanged.
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