title: Bridging the gap in heart transplantation.
abstract: OBJECTIVE
  Countries in Europe and in the USA are proclaiming their need for an objective allocation system that can cope with distribution of a scarce resource in a changing environment of an older donor and recipient population and of an increased number of patients on mechanical circulatory support, whose prospects are increasing.
  
  
  RESULTS
  The current heart allocation systems in Eurotransplant, France and the USA are all urgency tier systems, where within the same tier a first-come, first-served principle is applied. Both Eurotransplant and France are developing new heart allocation schemes that hinge on a benefit principle, thereby combining the prospects of patients after transplantation with their expected clinical course while on the waiting list. In the USA, a different approach has been chosen for their new allocation scheme, as the medical urgency of the patient is the driving force behind the proposal.
  
  
  CONCLUSIONS
  Policies to ensure a fair, efficient, and medically optimal matching of donor organs and recipients are continually evaluated and refined. The ethical cornerstone of each organ allocation policy in the described countries is the effort of balancing justice and utility.
authors.affiliation: aEurotransplant International Foundation, Leiden, the Netherlands bUniversity Hospital Vienna, Vienna, Austria.
authors.forename: Jacqueline M
authors.initials: JM
authors.lastname: Smits
authors.forename: Undine
authors.initials: U
authors.lastname: Samuel
authors.forename: Guenther
authors.initials: G
authors.lastname: Laufer
mesh_terms: D016027:Heart Transplantation / Q000379:methods*; D006801:Humans; D014019:Tissue Donors / Q000941:ethics*; D009927:Tissue and Organ Procurement / Q000379:methods*; D014850:Waiting Lists