Session Name: Heart and VADs: All Topics
Session Date & Time: None. Available on demand.
*Purpose: Describe and explain variations in listing practice among U.S. transplant centers in response to the new allocation policy.
*Methods: We performed an observational cohort study comparing adult, heart-alone transplant candidates listed post-policy (December 2018 – February 2020) to a seasonally matched, pre-policy cohort (December 2016 – February 2018). We used mixed-effect logistic regression models to estimate each transplant center’s expected and observed rate of high-priority status listing, and the association of pre-policy organ procurement organization (OPO) characteristics with the policy effect.
*Results: Similar numbers of candidates were listed by U.S. transplant centers (N = 96) in each policy period (4,472 vs. 4,498). The average transplant center had greater odds of utilizing high-priority status than expected (OR: 6.34; 95% CI: 5.08-7.91), after adjusting for candidate characteristics. Ninety-one of 96 (94.8%) centers listed significantly more candidates at high-priority status than expected, with the unexpected increase varying from 4.8% to 50.4% (IQR: 14.0% – 23.3%). Compared with the average center, centers in OPOs with high rate of transplantation among high-priority candidates under the previous allocation scheme were significantly more likely to list candidates at high-priority status under the new policy (OR: 9.73, p = 0.01).
*Conclusions: While listing behavior varied substantially between transplant centers in response to the new allocation policy, the utilization of high-priority statuses exceeded expectations in almost all centers. Widespread changes in transplant center practices may undermine the effectiveness of the new heart allocation policy.
To cite this abstract in AMA style:Ran G, Chung K, Anderson AS, Gibbons R, Narang N, Churpek M, Parker WF. Geographic Variation in Candidate Listing Behavior Under the New Heart Allocation Policy [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/geographic-variation-in-candidate-listing-behavior-under-the-new-heart-allocation-policy/. Accessed September 23, 2021.
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