Background: OPTN policy 3.7.3(a)(i) allows heart transplant candidates with ventricular assist devices (VAD) to be listed as Status 1A for 30 days at any time after the device is implanted (Status 1A VAD). Given current concern regarding the continued relevance of this policy, we evaluated Status 1A use practices for candidates with VADs.

Methods: Using Scientific Registry of Transplant Recipients standard analysis files, we examined adults actively awaiting heart transplant, 7/1/09-6/30/11, with follow-up through 10/31/11. Candidates reporting multiple device implantations (n=274) were excluded.

Results: 35% (2549/7230) of adult candidates on the heart waiting list were reported to have one VAD at any time while listed; 40% had not used any 1A VAD time, 30% used 1-29 days, and 30% used all their 1A VAD time during an average of 11 months waiting time (median 7 mos). 10% of candidates who used at least some Status 1A VAD time split it into multiple periods. Among all candidates with prior VAD, 22% underwent heart transplant as Status 1A VAD, 21% as Status 1A for other reasons, 19% as Status 1B and <1% as Status 2. 20% of candidates with a VAD were listed as Status 1A for reasons other than VAD for at least one day; of those, the mean 1A time was 71 days (SD 78.2 days). Of candidates who used none or partial 1A VAD time, 36% underwent transplant at a status other than 1A VAD. 17% of candidates who used all 30 days of 1A VAD time died.

Conclusion: Despite an allocation policy that prioritizes VADs, less than one-fourth of candidates with VADs undergo transplant as Status 1A VAD, due to either exhaustion of 1A VAD time or listing under alternate status. Furthermore, there is variability in how 1A VAD time is used. Further investigation is needed to determine the impact of eliminating or extending the 1A VAD policy.

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