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)
Part of the following topical collections:
  1. Topical Collection on Heart Failure


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.


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.


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 



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


Mechanical support


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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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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