Center-Level Variation in Transplant Rates Following the Heart Allocation Policy Change

Abstract

IMPORTANCE Wide state-level variability in waiting list outcomes have been noted for patients listed for heart transplant in the US, but little is known regarding center-level transplant rates since the heart allocation policy change. OBJECTIVETo evaluate center-level transplant rates following the recent allocation policy change for heart transplant. DESIGN, SETTING, AND PARTICIPANTSThis cohort study used data from the United Network for Organ Sharing database from October 18, 2015, to March 1, 2020, for a nationwide analysis of transplant centers in the US. Transplant candidates were stratified into 2 time cohorts, with era 1 denoting the 3-year period before the policy change (October 18, 2018), and era 2 representing the 500-day period after the policy change but before the beginning of the COVID-19 pandemic. Data were analyzed from May to June 2021. EXPOSUREThe heart allocation policy change enacted on October 18, 2018. MAIN OUTCOMES AND MEASURESCompeting risk regression for waiting list outcomes was performed to calculate adjusted era 1 and era 2 center-level transplant rates. Rates were compared across regions and states, as well as within organ procurement organizations. Pearson correlation coefficient was used to assess center-level factors associated with era 2 transplant rates. RESULTSOf 15 940 transplant candidates included for analysis, 5063 (median [IQR] age, 56 [45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62][63] years; 1385 women [27.4%]) comprised the era 2 cohort. The proportion of patients with temporary mechanical circulatory support increased between era 1 and era 2 (extracorporeal membrane oxygenation, 2.00% vs 3.42%; percutaneous ventricular assist device, 0.66% vs 1.86%; intra-aortic balloon pump, 5.21% vs 13.10%). The adjusted mean center-level likelihood of transplant increased after the rule change (from 48.1% in era 1 to 78.0% in era 2). Significant variation in transplant rates was observed across regions and states even among centers with shared organ procurement organizations. The largest absolute difference in transplant rates was 27.1% for 2 centers belonging to the same organ procurement organization. Centers with higher transplant volumes in era 2 and with a greater proportion of candidates with intra-aortic balloon pump were observed to have higher transplant rates.CONCLUSIONS AND RELEVANCE Despite sharing organ supply and having a small geographical distance, these findings suggest that intercenter disparities in the likelihood of transplant have persisted following the heart allocation policy change. Further work is necessary to ensure equitable allocation of organs in heart transplant.

Application of Hydrogels as Three-Dimensional Bioprinting Ink for Tissue Engineering

“…Total organ transplantation is currently one of the best ways to treat end-stage organ diseases. Although the number of organ donations has gradually increased in the past decades, the supply of solid organ transplants is still far from meeting the demand [1]. It is a pity that there were over 150 thousand candidates on the waiting list in Europe in 2018, but only 34,221 organ transplants were achieved that year [2].…”

Left Ventricular Assist Device Outcomes and Strategy 5 Years from Heart Transplant Allocation Score Change

“…The scoring system changed in several ways, but notably by further stratifying the existing three categories into six and deprioritizing stable candidates with left ventricular assist devices (LVADs). 1,2 We examined the impact of these policy changes on rates of LVAD implantation and post-transplant outcomes.…”