title: Proceedings of the AST heart allocation meeting at the American Transplant Congress, Philadelphia, Pennsylvania, May 4, 2015.
abstract: Ensuring fair and equitable allocation of donor hearts in the US is the charge of the Organ Procurement and Transplantation Network (OPTN). However, the recent increase of candidates waiting without a corresponding increase in available donors, higher waitlist mortality rates in higher status patients, the presence of disadvantaged subgroups, and the changing management of heart failure patients with increased VAD usage, has necessitated review of allocation policy. Therefore, the Heart Subcommittee of the OPTN/UNOS Thoracic Committee is exploring a further-tiered allocation system, devising a "straw man" model as a starting point for modeling analyses and public discussion. On May 4, 2015, an American Society of Transplantation (AST)-endorsed forum to discuss these potential proposed changes took place. Attendees included 41 people, mostly highly experienced transplant cardiologists and cardiothoracic surgeons, representing 19 heart transplant centers across the US, UNOS, and the Scientific Registry of Transplant Recipients (SRTR). There was unanimous agreement that the potential proposed policy will require careful wording to avoid ambiguity and "gaming" of the system, and strong support for abolishment of local organ sharing in favor of geographic sharing. However, contention existed concerning the appropriate prioritization levels of ECMO, temporary VAD/TAH patients as well as the 30-day LVAD listing.
authors.affiliation: Cedars-Sinai Heart Institute, Los Angeles, CA, USA.
authors.forename: Jon
authors.initials: J
authors.lastname: Kobashigawa
authors.affiliation: University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Teuteberg
authors.affiliation: University of Michigan, Ann Arbor, MI, USA.
authors.forename: Monica
authors.initials: M
authors.lastname: Colvin
authors.affiliation: United Network for Organ Sharing, Richmond, VA, USA.
authors.forename: Leah
authors.initials: L
authors.lastname: Edwards
authors.affiliation: Cedars-Sinai Heart Institute, Los Angeles, CA, USA.
authors.forename: Tiffany
authors.initials: T
authors.lastname: Daun
authors.affiliation: Cedars-Sinai Heart Institute, Los Angeles, CA, USA.
authors.forename: Minh
authors.initials: M
authors.lastname: Luu
authors.affiliation: Cedars-Sinai Heart Institute, Los Angeles, CA, USA.
authors.forename: Jignesh
authors.initials: J
authors.lastname: Patel
authors.affiliation: Emory University, Atlanta, GA, USA.
authors.forename: John David
authors.initials: JD
authors.lastname: Vega
authors.affiliation: University of Texas Southwestern, Dallas, TX, USA.
authors.forename: Dan
authors.initials: D
authors.lastname: Meyer
mesh_terms: D003226:Congresses as Topic; D033001:Directed Tissue Donation; D015276:Health Care Rationing; D006331:Heart Diseases / Q000601:surgery*; D016027:Heart Transplantation; D006801:Humans; D040841:Resource Allocation; D009927:Tissue and Organ Procurement; D014481:United States; D014850:Waiting Lists
keywords: cardiac transplantation; exceptions; heart allocation; mechanical circulatory support; policy; sensitized patients