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Time Is a Precious Commodity: 2018 OPTN Policy Change and the Potential to Lower Heart Transplant Waitlist Time in the Sickest Patients

  • Jamael Hoosain
  • Shelley Hankins
Heart Failure (HJ Eisen, Section Editor)
  • 93 Downloads
Part of the following topical collections:
  1. Topical Collection on Heart Failure

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.

Keywords

The 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 

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

Notes

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.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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    OPTN Website. https://optn.transplant.hrsa.gov/. Accessed on October 7, 2018.
  2. 2.
    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.
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    •• 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.
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    • 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.
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    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.

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Jamael Hoosain
    • 1
  • Shelley Hankins
    • 1
    • 2
  1. 1.PhiladelphiaUSA
  2. 2.Drexel University College of MedicinePhiladelphiaUSA

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