Cardiac specialists recommend donor heart allocation changes

Photo: Hands with surgical gloves hold a symbolic heart

A group of leading cardiac specialists has proposed new guidelines for the allocation of donor hearts to patients awaiting transplant; © Robert Byron

A group of leading cardiac specialists has proposed new guidelines for the allocation of donor hearts to patients awaiting transplant. The changes are aimed at improving the organ distribution process to increase the survival rate of patients awaiting transplant and posttransplant.

The proposed guidelines would replace a three-tiered system adopted in 1998. "We think the proposed, modified multitiered allocation system embraces the key aspects of our charge, providing organs to the group of patients with the greatest need and who will gain the greatest benefit from heart transplant," said Dan M. Meyer, M.D., a cardiothoracic surgeon with Scripps Health and former chairman of the heart subcommittee for the United Network for Organ Sharing (UNOS).

Recommended changes include considering a patient's severity of illness, estimates of waiting list mortality and posttransplant survival, geographic variations in heart allocations, the emerging population of patients surviving with ventricular assist devices and other potentially disenfranchised groups.

The inclusion of additional tiers provides further stratification of the patients' level of illness, taking into account the expected waiting list mortality and posttransplant survival, rather than having time on the waiting list be a major driver of organ allocation.

UNOS serves as the Organ Procurement and Transplantation Network through its contract with the U.S. Department of Health and Human Services. Ensuring equitable and fair distribution of donor organs is a key responsibility of UNOS/OPTN, which asked its heart subcommittee to assess the limitations of the current three-tiered system because the waiting list for organs has continued to grow while the number of donor organs has not. The current heart allocation system, based upon urgency, waiting time, geography and blood type, was first introduced in 1988 and has had only two major policy changes since then.

The heart subcommittee includes regional and at-large representatives from heart failure cardiology, surgery, administrators from organ procurement organizations, a patient advocacy representative, and transplant coordinators.

The proposal provides a framework for simulation modeling that will allow the committee to project whether transplant candidates would have better waitlist survival in the revised allocation system, and whether posttransplant survival would remain stable. After conducting further review and analysis, the committee will present the proposed changes for public comment. The committee will then make necessary changes before presenting the proposed guidelines to UNOS.

"Much of the impetus for this change in the allocation system stems from the dramatic increase in the use of ventricular assist devices for end-stage heart failure, an area that Scripps has focused on through the development of our successful Mechanical Circulatory Support Program," Meyer said. "Ventricular assist devices help to stabilize many patients on the waiting list."; Source: Scripps Health