Effects of the 2006 U.S. thoracic organ allocation change: analysis of local impact on organ procurement and heart transplantation.
BACKGROUND
The United Network for Organ Sharing (UNOS) implemented a thoracic organ allocation policy change (APC) in July 2006 that aimed to reduce death on the waiting list by expanding regional organ sharing. As such, organs would be allocated to the sickest recipients with highest listing status across the region. Our aim was to determine the impact of the new policy on the procurement and transplant process within our program.


METHODS
We analyzed data supplied by UNOS as the contractor for the Organ Procurement and Transplantation Network and from the local organ procurement organization for 2 years before and 2 years after implementation of the APC.


RESULTS
The APC resulted in an increase in the proportion of Status 1A patients transplanted (24% to 43%, p = 0.015) and a decrease in the proportion of Status 2 patients transplanted (56% to 24%, p = 0.001). Significant increases were observed in mean graft ischemic time (196 minutes to 223 minutes, p = 0.022), number of patients transplanted with ventricular assist devices (17% to 31%, p = 0.036), and procurement costs. There was no significant difference in waiting-list mortality (6% to 5%, p = 0.75) and short-term post-transplant survival.


CONCLUSIONS
The 2006 change in UNOS organ allocation policy resulted in an increase in Status 1A transplants, graft ischemic time and procurement costs, and a decrease in Status 2 transplants, but no effect on mortality on the waiting list within our center. To assess the full effect of the APC on outcomes, the long-term impact of the increased graft ischemic time on survival should be quantified.
Nativi
Jose N
JN
U.T.A.H. Cardiac Transplant Program, Salt Lake City, Utah, USA.
Kfoury
Abdallah G
AG
Myrick
Craig
C
Peters
Melissa
M
Renlund
Dale
D
Gilbert
Edward M
EM
Bader
Feras
F
Singhal
Arun K
AK
Everitt
Melanie
M
Fisher
Patrick
P
Bull
David A
DA
Selzman
Craig
C
Stehlik
Josef
J
D000328:Adult; D005260:Female; D006291:Health Policy / Q000639:trends*; D006331:Heart Diseases / Q000401:mortality / Q000628:therapy; D016027:Heart Transplantation / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends*; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D040841:Resource Allocation / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends*; D015996:Survival Rate; D009927:Tissue and Organ Procurement / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends*; D014481:United States; D014850:Waiting Lists