Recent Changes and Future Challenges in the Heart Allocation System

Abstract

The limited number of donor hearts is one of the greatest and persistent challenges to heart transplantation. Allocation of this precious resource requires the integration of objective data, clinical intuition, and moral fairness. Institution of an allocation system by UNOS has provided important structure to the allocation methodology. The system must be periodically reviewed and reorganized to ensure it is reflective of current patient disease and clinical practice and builds upon the knowledge of previous paradigms. Since the establishment of the 2006 allocation system, not only has there been a dramatic increase in the number of heart transplant candidates but also a dramatic increase in the number of patients qualifying as high-priority candidates. To address these changes, UNOS Thoracic Organ Transplantation Committee was tasked with providing a revised allocation system. The resulting system aims to improve waitlist mortality and posttransplant outcomes by better prioritizing the highest acuity patients while improving the geographic distribution of organ offers.