Document Type
Article
Publication Date
3-30-2021
Abstract
The United Network for Organ Sharing (UNOS) recently revised its heart allocation policy to address numerous shortcomings of the previous system. Implemented in 2018, the changes sought to reduce waiting list mortality, clearly define urgency status based on objective physiologic variables, decrease exemption requests, and introduce geographic modifications to ensure organ distribution favors the highest urgency candidates. In large part, UNOS policy revisions were driven by the growing use of continuous flow left ventricular assist devices (CF-LVADs) and the relevant device complications that led to an unacceptably high number of status exemptions. The new 6-tiered system assigns a comparatively lower urgency status to patients supported on CF-LVADs and higher urgency to patients supported on short-term mechanical circulatory assist (MCA) such as extracorporeal membrane oxygenation (ECMO) and intraaortic balloon pump (IABP) counterpulsation. LVAD use as bridge to transplant (BTT) therapy increased steadily throughout the preceding decade due to technological improvements and increased physician familiarity, but the recent policy changes introduce incentives for physicians to withhold this life-saving therapy in order to achieve higher urgency status for their patients. This paper will explore the technological evolution of MCA and the pertinent clinical trials that have led to their FDA approval as BTT and destination therapy. A review of the inception and development of the donor allocation system will be provided before examining available post-policy outcome data. Finally, we will highlight successes and shortcomings of the implemented changes before commenting on areas to potentially expand upon the existing policy.
Recommended Citation
Tatum, Robert T; Massey, H Todd; and Tchantchaleishvili, Vakhtang, "Impact of mechanical circulatory support on donor heart allocation: past, present, and future." (2021). Department of Surgery Faculty Papers. Paper 198.
https://jdc.jefferson.edu/surgeryfp/198
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.
PubMed ID
33792245
Language
English
Comments
This article is the author's final published version in Reviews in Cardiovascular Medicine, Volume 22, Issue 1, 30 March 2021, Pages 25-32.
The published version is available at https://doi.org/10.31083/j.rcm.2021.01.230.
Copyright © 2021 The Authors. Published by IMR Press.
his is an open access article under the CC BY 4.0 license (https://creativecommons.org/licenses/by/4.0/).