Background
In 2018, a new heart allocation policy was introduced to reduce variability in access
to and outcomes after transplantation, in part, through attempts at broader geographic
sharing of donor hearts. We evaluated how this policy affected geographic sharing
and waitlist outcomes by donation service area (DSA).
Methods
This retrospective study of the Scientific Registry of Transplant Recipients database
included adult patients waitlisted between October 2016 and October 2020, stratified
by policy period. Our primary outcomes were mean proportion of imported and exported
hearts aggregated by DSA as well as time to transplant.
Results
Following the policy change, there was substantial evidence of sharing across DSAs.
The mean proportion of imported hearts transplanted by a DSA increased from 32% (95%
CI: 27%-36%) to 74% (95% CI: 71%-78%; p < 0.001), and the mean proportion of exported hearts increased from 37% (95% CI:
33%-42%) to 75% (95% CI: 71%-79%; p < 0.001). The mean sharing ratio, defined as the log-transformed ratio of imported
to exported hearts per DSA, shifted from 1.15 (95% CI: 0.88-1.42) to 1.02 (95% CI:
0.96-1.07), with a 76% decline in the variance across DSAs. As sharing increased,
time to transplant per DSA declined from 153.9 days (95% CI, 143.4-164.4 days) pre-policy
to 89.6 days (95% CI, 83.1-96.1 days) post-policy (p < 0.001). A larger decrease in waitlist time was associated with a higher proportion
of exported hearts.
Conclusions
The 2018 heart allocation policy was associated with more uniform access to heart
transplantation and improved waitlist outcomes.
KEYWORDS
Abbreviations:
CDC (Centers for Disease Control), CIF (Cumulative Incidence Functions), DSA (Donation Service Area), HRSA (Health Resources and Services Administration), O/E (Observed/Expected), OPO (Organ Procurement Organization), SRTR (Scientific Registry of Transplant Recipients), TSAM (Thoracic Simulated Allocation Model)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: February 18, 2023
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 International Society for Heart and Lung Transplantation. All rights reserved.
