Abstract
Purpose of Review
Heart transplantation is the gold standard therapy for end-stage heart failure; however, the donor pool is limited, making this a scarce resource that must be allocated to the sickest patients in an efficient, fair, and equitable manner. The allocation policies have been constantly revised over the years to refine the process. We will explore the new heart allocation system, OPTN-Policy 6, as well as, review why these changes were necessary.
Recent Findings
Over the past decade, the number of active heart transplant candidates nearly doubled, with a dramatic increase in the number of status 1A and 1B (high priority) candidates. Candidates have also faced increased waitlist times with geographic variances. The allocation policy changes will attempt to alleviate these problems as well as adapt to advances in technology.
Summary
The new allocation policy is designed to adapt to the present day reality of expanded mechanical support use, increased candidate acuity, increasing waiting times, and geographical disparities in transplant rates. Though the implementation of the new allocation policy will require some change in practice, the transplant community, as knowledge is gained, is accustomed to change and refinement in practice, in an effort to improve outcomes for patients with end-stage heart failure.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Abbreviations
- OPTN:
-
The Organ Procurement and Transplantation Network
- UNOS:
-
The United Network for Organ Sharing
- OPO:
-
Organ procurement organizations
- HHS:
-
US Department of Health and Human Services
- RRB:
-
Regional review boards
- SRTR:
-
Scientific Registry of Transplant Recipients
- MCS:
-
Mechanical support
References
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
OPTN Website. https://optn.transplant.hrsa.gov/. Accessed on October 7, 2018.
Organ Procurement and Transplantation Network. OPTN bylaws appendix C. March 2004. Available at: http://optn.transplant.hrsa.gov/policiesAndBylaws/bylaws.asp. , Accessed on October 7, 2018.
•• Organ Procurement and Transplantation Network (OPTN) Policies – Policy 6 https://optn.transplant.hrsa.gov/media/1200/optn_policies.pdf#nameddest=Policy_06. Accessed on October 7, 2018 Policy document outlining the OPTN policies that currently govern operations of all transplant hospitals, organ procurement organizations and histocompatibility labs in the U.S.
Colvin-Adams M, Valapour M, Hertz M, Heubner B, Paulson K, Dhungel V, et al. Lung and heart allocation in the United States. Am J Transplant. 2012;12:3213–34. https://doi.org/10.1111/j.1600-6143.2012.04258.x.
•• Colvin M, Smith JM, Hadley N, Skeans MA, Carrico R, Uccellini K, et al. SRTR 2016 annual data report: heart. Am J Transplant. 2018;18(Suppl 1):291–362. https://doi.org/10.1111/ajt.14561 This is the annual data report for heart transplants by the OPTN/SRTR from 2016. This document describes the outcomes in 2016 as compared to prior years.
Scientific Registry of Transplant Recipients. Current Annual ADR, https://srtr.transplant.hrsa.gov/annual_reports/Default.aspx ,Accessed Oct 22, 2018.
Proposal to modify the adult heart allocation system; OPTN/UNOS thoracic organ transplantation committee, https://optn.transplant.hrsa.gov/media/1921/thoracic_adult_heart_allocation_modification_20160815.pdf. Accessed on October 7, 2018.
• Impact Summaries OPTN/UNOS BOARD OF DIRECTORS December 2016 https://optn.transplant.hrsa.gov/media/1996/impactsummaries_201612.pdf. Accessed on October 7, 2018. The impact summary provides a synopsis of the details about who is affected by the proposal and the ways in which it aligns with OPTN Strategic Goals and the OPTN Final Rule.
Modifications to the Adult Heart Allocation System Frequently Asked Questions https://optn.transplant.hrsa.gov/media/2688/adult-heart_revised-faq_20181008.pdf. Accessed on October 7, 2018.
Summary of actions taken at OPTN/UNOS Board of Directors Meeting (November 12–13, 2012) and OPTN/UNOS Executive Committee Meetings (August 28, 2012; October 19, 2012; and November 12, 2012) https://optn.transplant.hrsa.gov/media/1274/policynotice_20121201.pdf. Accessed on October 7, 2018.
Author information
Authors and Affiliations
Ethics declarations
Conflict of Interest
J. Hoosain and S. Hankins declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
This article is part of the Topical Collection on Heart Failure.
Rights and permissions
About this article
Cite this article
Hoosain, J., Hankins, S. Time Is a Precious Commodity: 2018 OPTN Policy Change and the Potential to Lower Heart Transplant Waitlist Time in the Sickest Patients. Curr Cardiol Rep 21, 67 (2019). https://doi.org/10.1007/s11886-019-1150-8
Published:
DOI: https://doi.org/10.1007/s11886-019-1150-8