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The New Heart Allocation Policy Has Increased Listing by Exception

J. R. Golbus1, Y. Ahn2, B. K. Nallamothu1, M. N. Walsh3, D. Zaun2, A. Israni2, M. Colvin1

1University of Michigan, Ann Arbor, MI, 2Hennepin Healthcare Research Institute, Minneapolis, MN, 3Ascension St. Vincent Heart Center, Carmel, IN

Meeting: 2022 American Transplant Congress

Abstract number: 1116

Keywords: Allocation, Heart transplant patients, Outcome, Public policy

Topic: Clinical Science » Heart » 63 - Heart and VADs: All Topics

Session Information

Session Name: Heart and VADs: All Topics

Session Type: Poster Abstract

Date: Sunday, June 5, 2022

Session Time: 7:00pm-8:00pm

 Presentation Time: 7:00pm-8:00pm

Location: Hynes Halls C & D

Session Information

Session Name: Poster Chat: Heart and Lung

Session Type: Poster Chat

Date: Tuesday, June 7, 2022

Session Time: 7:00pm-8:00pm

 Presentation Time: 7:00pm-8:00pm

Location: Hynes Hall C

*Purpose: The new heart allocation policy (October 2018) expanded the number of listing statuses and established a national review board for exception requests in an effort to reduce these requests. We examined whether the new policy has achieved this goal and improved survival among higher-urgency statuses.

*Methods: Using the Scientific Registry of Transplant Recipients database, we assessed the number of patients listed by exception and performed unadjusted Kaplan-Meier survival analyses to determine the impact of listing by exception on 1-year post-transplant survival pre- and post-policy change. We included adult heart transplant recipients waitlisted and transplanted from February 1, 2016, to June 30, 2020, excluding October 2018. The study period was divided into 2 20-month periods: pre-policy (02/2016 to 09/2017) and post-policy (11/2018 to 06/2020).

*Results: Pre-policy, 3133 candidates were listed and transplanted, of whom 204 (6.5%) were by status 1A exception. Post-policy, 3790 candidates were listed and transplanted, of whom 1210 (31.9%) were by exception at statuses 1 to 4. Overall, there were no differences in 1-year post-transplant survival by status pre-policy (p=0.40) or post-policy (p=0.05) change. However, pre-policy 1-year survival was significantly lower for candidates transplanted by exception compared with those transplanted using standard criteria (p=0.03) (Table 1). Post-policy, 1-year survival was similar for candidates transplanted by exception compared with those transplanted using standard criteria, except for those transplanted at status 4 by exception, who had significantly better 1-year survival than those transplanted using standard criteria (p=0.03) (Table 1).

*Conclusions: Despite expansion of listing statuses, post-policy transplants by exception increased significantly, demonstrating that the goals of the new policy have not been met. Candidates transplanted status 4 exception had significantly better 1-year survival and may differ in important ways from the larger pool of status 4 candidates. Institution of a national review board may have inadvertently contributed to an increase in transplants by exception.

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To cite this abstract in AMA style:

Golbus JR, Ahn Y, Nallamothu BK, Walsh MN, Zaun D, Israni A, Colvin M. The New Heart Allocation Policy Has Increased Listing by Exception [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/the-new-heart-allocation-policy-has-increased-listing-by-exception/. Accessed May 9, 2025.

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