New system, old problem: Increased wait time for high-priority transplant candidates

Erin Harris; Lorenzo Sewanan; Veli K Topkara; Justin A Fried; Jayant Raikhelkar; Paolo C Colombo; Melana Yuzefpolskaya; Ersilia M DeFilippis; Farhana Latif; Koji Takeda; Sameer Singh; Nir Uriel; Gabriel Sayer; Kevin J Clerkin

doi:10.1016/j.healun.2023.07.012

New system, old problem: Increased wait time for high-priority transplant candidates

J Heart Lung Transplant. 2023 Nov;42(11):1497-1500. doi: 10.1016/j.healun.2023.07.012. Epub 2023 Jul 26.

Affiliations

¹ Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York.
² Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, New York.
³ Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York. Electronic address: kjc2142@cumc.columbia.edu.

PMID: 37506955
DOI: 10.1016/j.healun.2023.07.012

Abstract

The 2018 heart allocation policy sought to improve risk stratification and reduce waitlist mortality for the sickest patients. This study sought to evaluate changes in wait times for the highest priority patients since policy implementation. All adult single-organ transplant recipients were identified in the United Network for Organ Sharing registry from October 18, 2018, to July 8, 2022, and separated into 4 periods. Outcomes were compared by blood type and UNOS region. Over the study period, 897 of 9,143 patients were listed as status 1 with no significant change in median wait time by blood type or region. More patients were listed as status 2 (4,523/9,143), and each subsequent period postpolicy change was associated with a 4.2-day increase in mean status 2 waitlist time (95% confidence interval 3.0-5.5, p < 0.0001). Wait times were longest for candidates with blood type O and shortest for AB & A. Regional variations continued, however, wait time increased in every region over time.

Keywords: UNOS registry; heart allocation policy; heart transplantation; mechanical circulatory support; waitlist mortality.