Minimal Effect of Broader Heart Sharing on Regional Outcomes.

A. Bitar,¹ M. Skeans,² R. Davies,³ M. Farr,⁴ A. Kao,⁵ L. Robbins-Callahan,⁶ J. Rogers,⁷ S. Silvestry,⁸ M. Colvin.^1,2

¹U of MI, Ann Arbor, MI
²SRTR, Mpls, MN
³Nemours/AIDHC, Wilmington, DE
⁴Columbia U, NY, NY
⁵Mid-America Heart Inst, KC, MO
⁶UNOS, Richmond, VA
⁷Duke U, Durham, NC
⁸FL Hosp Transplant Inst, Orlando, FL

Meeting: 2017 American Transplant Congress

Abstract number: 34

Keywords: Allocation, Heart

Session Information

Session Name: Concurrent Session: Heart Waitlist and Allocation: Working to Get It Right

Session Type: Concurrent Session

Date: Sunday, April 30, 2017

Session Time: 2:30pm-4:00pm

Presentation Time: 2:42pm-2:54pm

Location: E267

The OPTN/UNOS Heart Subcommittee proposed a revision to policy 6 (Allocation of Hearts and Heart-Lungs) to better address heart transplant candidate medical urgency. They developed a 6-status medical urgency algorithm and investigated 4 geographic sharing strategies. We determined the impact of a proposed broader sharing rule (Share 1/2A) on regional outcomes under the 6-status system. Share 1/2A combines zone A with local sharing and shares to zone B for statuses 1 and 2 before making offers to status 3.

Using Thoracic Simulated Allocation Model (TSAM) software and OPTN data, we determined the impact of Share 1/2A on regional transplant rates, waitlist mortality, and posttransplant mortality. We compared the results with current allocation rules. The study included 9725 heart and 188 heart/lung candidates listed for at least 1 day from July 1, 2009, to June 30, 2011.

Compared with current rules, Share 1/2A had little impact or moderated transplant rates (Fig 1). In regions with lower transplant rates under current rules, rates increased with Share 1/2A (regions 1 and 9) or remained similar (regions 4 and 7). In regions with higher rates under current rules, rates declined with Share 1/2A (regions 3 and 8) or remained similar (regions 2, 5, and 6). Rates increased in regions with larger proportions of status 1, 2, or 3 candidates and decreased in regions with lower proportions. Overall and in every region, average waitlist mortality rates declined with Share 1/2A. Posttransplant mortality was similar under current rules and Share 1/2A. The balance of importing and exporting organs remained similar under Share 1/2A and current rules.

Conclusion: Under simulation, broader sharing using Share 1/2A and a 6-status allocation system had little impact or moderated regional transplant rates compared with current rules, and generally decreased regional waitlist mortality rates.

CITATION INFORMATION: Bitar A, Skeans M, Davies R, Farr M, Kao A, Robbins-Callahan L, Rogers J, Silvestry S, Colvin M. Minimal Effect of Broader Heart Sharing on Regional Outcomes. Am J Transplant. 2017;17 (suppl 3).

To cite this abstract in AMA style:

Bitar A, Skeans M, Davies R, Farr M, Kao A, Robbins-Callahan L, Rogers J, Silvestry S, Colvin M. Minimal Effect of Broader Heart Sharing on Regional Outcomes. [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/minimal-effect-of-broader-heart-sharing-on-regional-outcomes/. Accessed November 21, 2024.

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