Effects of the 2006 U.S. thoracic organ allocation change: Analysis of local impact on organ procurement and heart transplantation

Jose N. Nativi, Abdallah G. Kfoury, Craig Myrick, Melissa Peters, Dale Renlund, Edward M. Gilbert, Feras Bader, Arun K. Singhal, Melanie Everitt, Patrick Fisher, David A. Bull, Craig Selzman, Josef Stehlik

Research output: Contribution to journalArticlepeer-review

33 Scopus citations

Abstract

Background: The United Network for Organ Sharing (UNOS) implemented a thoracic organ allocation policy change (APC) in July 2006 that aimed to reduce death on the waiting list by expanding regional organ sharing. As such, organs would be allocated to the sickest recipients with highest listing status across the region. Our aim was to determine the impact of the new policy on the procurement and transplant process within our program. Methods: We analyzed data supplied by UNOS as the contractor for the Organ Procurement and Transplantation Network and from the local organ procurement organization for 2 years before and 2 years after implementation of the APC. Results: The APC resulted in an increase in the proportion of Status 1A patients transplanted (24% to 43%, p = 0.015) and a decrease in the proportion of Status 2 patients transplanted (56% to 24%, p = 0.001). Significant increases were observed in mean graft ischemic time (196 minutes to 223 minutes, p = 0.022), number of patients transplanted with ventricular assist devices (17% to 31%, p = 0.036), and procurement costs. There was no significant difference in waiting-list mortality (6% to 5%, p = 0.75) and short-term post-transplant survival. Conclusions: The 2006 change in UNOS organ allocation policy resulted in an increase in Status 1A transplants, graft ischemic time and procurement costs, and a decrease in Status 2 transplants, but no effect on mortality on the waiting list within our center. To assess the full effect of the APC on outcomes, the long-term impact of the increased graft ischemic time on survival should be quantified.

Original languageEnglish (US)
Pages (from-to)235-239
Number of pages5
JournalJournal of Heart and Lung Transplantation
Volume29
Issue number3
DOIs
StatePublished - Mar 2010
Externally publishedYes

Keywords

  • heart transplantation
  • organ donation
  • organ procurement
  • transplant waiting list
  • waiting list mortality

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation

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