title: Transplant registrants with implanted left ventricular assist devices have insufficient risk to justify elective organ procurement and transplantation network status 1A time.
abstract: OBJECTIVE
  The goal of this research was to identify disparities in risk within heart transplant urgency designations.
  
  
  BACKGROUND
  Patients with left ventricular assist devices (LVADs) are given 30 days of elective status 1A time. This allowance may create competition for organs between stable LVAD-supported registrants and less stable registrants listed status 1A or 1B.
  
  
  METHODS
  The Scientific Registry of Transplant Recipients database was analyzed for all status 1A and 1B listings between 2005 and 2010. Cox models were used to estimate the relative and absolute risk of adverse events (death or delisting as too ill) during status 1A or 1B listing.
  
  
  RESULTS
  Status 1A registrants supported with dual inotropes and right heart monitoring had a higher risk of adverse events compared to those supported with implanted LVADs using elective 1A time (hazard ratio: 3.2; 95% confidence interval: 1.8 to 5.7). The 30-day risk of events was 1% (95% confidence interval: 0.1% to 3%) for implanted LVADs using elective 1A time and 6% (95% confidence interval: 4% to 8%) for dual inotrope support. Registrants listed with paracorporeal ventricular assist devices had a higher risk of adverse events (hazard ratio: 9.1; p < 0.0001) compared with registrants with implanted LVADs using elective 1A time. The odds of transplant were higher for implanted LVADs (odds ratio: 1.5; p < 0.0001) compared with dual-inotrope and intra-aortic balloon pump support.
  
  
  CONCLUSIONS
  The historic allowance for 30 days of elective status 1A time for implanted LVADs creates disparities in risk among status 1A registrants. The allowance of 30 days of elective status 1A time should not be allocated to stable registrants with implanted LVADs. Registrants supported with paracorporeal ventricular assist devices should be listed status 1A indefinitely.
authors.affiliation: Division of Cardiology, University of Washington, Seattle, WA 98195, USA. tdardas@uw.edu
authors.forename: Todd
authors.initials: T
authors.lastname: Dardas
authors.forename: Nahush A
authors.initials: NA
authors.lastname: Mokadam
authors.forename: Francis
authors.initials: F
authors.lastname: Pagani
authors.forename: Keith
authors.initials: K
authors.lastname: Aaronson
authors.forename: Wayne C
authors.initials: WC
authors.lastname: Levy
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D054624:Health Status Disparities; D006333:Heart Failure / Q000401:mortality / Q000601:surgery*; D016027:Heart Transplantation / Q000401:mortality; D006352:Heart Ventricles / Q000503:physiopathology / Q000601:surgery; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D016016:Proportional Hazards Models; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D009927:Tissue and Organ Procurement / Q000592:standards*; D014481:United States; D014850:Waiting Lists