*Purpose: Transplantation is often the gold standard therapy for those with organ failure, but limited supply prevents all patients from accessing this treatment. The Organ Procurement and Transplantation Network (OTPN) launched a publicly accessible dashboard which monitors equity in access to deceased donor (DD) transplantation for lung, liver, and kidney candidates. Most recently, heart was incorporated into the dashboard.

*Methods: OPTN data were analyzed using Poisson rate regression modeling and an access to transplant score (ATS) was created which summarizes a heart candidate’s relative likelihood of receiving a DD transplant, controlling for intentional policy-driven. The model was built on rolling 6-month cohorts of active heart registrations that waited at least one day between 1/1/2010 and 6/30/2021. The standard deviation (SD) in ATS was presented where smaller SDs are favorable and reflect a more equitable system.

*Results: The overall SD in ATS has remained stable over time for heart. After controlling for medical urgency status, donation service area (DSA), blood type, height and weight were the four factors most associated with inequity in the recent 6-month period. Blood type AB candidates had the highest transplant rates and blood type O the lowest. In addition, taller, less-heavy and younger candidates had better access.

*Conclusions: Overall, equity in access to DD heart transplant has remained relatively stable over the past decade despite major policy changes in 2018 (6 tiers) and 2020 (removal of DSA). The equity in access framework provides an additional tool for policy development and monitoring. Further research is need to investigate disparities associated with DSA which appear to have declined since 2018.

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