Time Is a Precious Commodity: 2018 OPTN Policy Change and the Potential to Lower Heart Transplant Waitlist Time in the Sickest Patients
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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.
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.
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.
KeywordsThe Organ Procurement and Transplantation Network The United Network for Organ Sharing Thoracic Organ Transplantation Committee Heart Allocation Policy Organ procurement organizations Organ allocation Regional review boards
The Organ Procurement and Transplantation Network
The United Network for Organ Sharing
Organ procurement organizations
US Department of Health and Human Services
Regional review boards
Scientific Registry of Transplant Recipients
Compliance with Ethical Standards
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.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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