Report from a forum on US heart allocation policy

J. A. Kobashigawa, M. Johnson, J. Rogers, J. D. Vega, M. Colvin-Adams, L. Edwards, D. Meyer, M. Luu, N. Reinsmoen, A. I. Dipchand, D. Feldman, R. Kormos, D. Mancini, S. Webber

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Since the latest revision in US heart allocation policy (2006), the landscape and volume of transplant waitlists have changed considerably. Advances in mechanical circulatory support (MCS) prolong survival, but Status 1A mortality remains high. Several patient subgroups may be disadvantaged by current listing criteria and geographical disparity remains in waitlist time. This forum on US heart allocation policy was organized to discuss these issues and highlight concepts for consideration in the policy development process. A 25-question survey on heart allocation policy was conducted. Among attendees/respondents were 84 participants with clinical/published experience in heart transplant representing 51 US transplant centers, and OPTN/UNOS and SRTR representatives. The survey results and forum discussions demonstrated very strong interest in change to a further-tiered system, accounting for disadvantaged subgroups and lowering use of exceptions. However, a heart allocation score is not yet viable due to the long-term viability of variables (used in the score) in an ever-developing field. There is strong interest in more refined prioritization of patients with MCS complications, highly sensitized patients and those with severe arrhythmias or restrictive physiology. There is also strong interest in distribution by geographic boundaries modified according to population. Differences of opinion exist between small and large centers. The authors provide a summary of the proceedings from a national forum on US heart allocation policy, which recommends a further-tiered allocation system to prioritize disadvantaged subgroups, among other policy changes. See editorial by Barr and Taylor (page 7) and special article by Meyer et al (page 44).

Original languageEnglish (US)
Pages (from-to)55-63
Number of pages9
JournalAmerican Journal of Transplantation
Volume15
Issue number1
DOIs
StatePublished - Jan 1 2015

Fingerprint

Vulnerable Populations
Transplants
Policy Making
Cardiac Arrhythmias
Survival
Mortality
Population
Surveys and Questionnaires

ASJC Scopus subject areas

  • Transplantation
  • Immunology and Allergy
  • Pharmacology (medical)

Cite this

Kobashigawa, J. A., Johnson, M., Rogers, J., Vega, J. D., Colvin-Adams, M., Edwards, L., ... Webber, S. (2015). Report from a forum on US heart allocation policy. American Journal of Transplantation, 15(1), 55-63. https://doi.org/10.1111/ajt.13033

Report from a forum on US heart allocation policy. / Kobashigawa, J. A.; Johnson, M.; Rogers, J.; Vega, J. D.; Colvin-Adams, M.; Edwards, L.; Meyer, D.; Luu, M.; Reinsmoen, N.; Dipchand, A. I.; Feldman, D.; Kormos, R.; Mancini, D.; Webber, S.

In: American Journal of Transplantation, Vol. 15, No. 1, 01.01.2015, p. 55-63.

Research output: Contribution to journalArticle

Kobashigawa, JA, Johnson, M, Rogers, J, Vega, JD, Colvin-Adams, M, Edwards, L, Meyer, D, Luu, M, Reinsmoen, N, Dipchand, AI, Feldman, D, Kormos, R, Mancini, D & Webber, S 2015, 'Report from a forum on US heart allocation policy', American Journal of Transplantation, vol. 15, no. 1, pp. 55-63. https://doi.org/10.1111/ajt.13033
Kobashigawa JA, Johnson M, Rogers J, Vega JD, Colvin-Adams M, Edwards L et al. Report from a forum on US heart allocation policy. American Journal of Transplantation. 2015 Jan 1;15(1):55-63. https://doi.org/10.1111/ajt.13033
Kobashigawa, J. A. ; Johnson, M. ; Rogers, J. ; Vega, J. D. ; Colvin-Adams, M. ; Edwards, L. ; Meyer, D. ; Luu, M. ; Reinsmoen, N. ; Dipchand, A. I. ; Feldman, D. ; Kormos, R. ; Mancini, D. ; Webber, S. / Report from a forum on US heart allocation policy. In: American Journal of Transplantation. 2015 ; Vol. 15, No. 1. pp. 55-63.
@article{af1165ca25de49a19bedd86eee56b7a8,
title = "Report from a forum on US heart allocation policy",
abstract = "Since the latest revision in US heart allocation policy (2006), the landscape and volume of transplant waitlists have changed considerably. Advances in mechanical circulatory support (MCS) prolong survival, but Status 1A mortality remains high. Several patient subgroups may be disadvantaged by current listing criteria and geographical disparity remains in waitlist time. This forum on US heart allocation policy was organized to discuss these issues and highlight concepts for consideration in the policy development process. A 25-question survey on heart allocation policy was conducted. Among attendees/respondents were 84 participants with clinical/published experience in heart transplant representing 51 US transplant centers, and OPTN/UNOS and SRTR representatives. The survey results and forum discussions demonstrated very strong interest in change to a further-tiered system, accounting for disadvantaged subgroups and lowering use of exceptions. However, a heart allocation score is not yet viable due to the long-term viability of variables (used in the score) in an ever-developing field. There is strong interest in more refined prioritization of patients with MCS complications, highly sensitized patients and those with severe arrhythmias or restrictive physiology. There is also strong interest in distribution by geographic boundaries modified according to population. Differences of opinion exist between small and large centers. The authors provide a summary of the proceedings from a national forum on US heart allocation policy, which recommends a further-tiered allocation system to prioritize disadvantaged subgroups, among other policy changes. See editorial by Barr and Taylor (page 7) and special article by Meyer et al (page 44).",
author = "Kobashigawa, {J. A.} and M. Johnson and J. Rogers and Vega, {J. D.} and M. Colvin-Adams and L. Edwards and D. Meyer and M. Luu and N. Reinsmoen and Dipchand, {A. I.} and D. Feldman and R. Kormos and D. Mancini and S. Webber",
year = "2015",
month = "1",
day = "1",
doi = "10.1111/ajt.13033",
language = "English (US)",
volume = "15",
pages = "55--63",
journal = "American Journal of Transplantation",
issn = "1600-6135",
publisher = "Wiley-Blackwell",
number = "1",

}

TY - JOUR

T1 - Report from a forum on US heart allocation policy

AU - Kobashigawa, J. A.

AU - Johnson, M.

AU - Rogers, J.

AU - Vega, J. D.

AU - Colvin-Adams, M.

AU - Edwards, L.

AU - Meyer, D.

AU - Luu, M.

AU - Reinsmoen, N.

AU - Dipchand, A. I.

AU - Feldman, D.

AU - Kormos, R.

AU - Mancini, D.

AU - Webber, S.

PY - 2015/1/1

Y1 - 2015/1/1

N2 - Since the latest revision in US heart allocation policy (2006), the landscape and volume of transplant waitlists have changed considerably. Advances in mechanical circulatory support (MCS) prolong survival, but Status 1A mortality remains high. Several patient subgroups may be disadvantaged by current listing criteria and geographical disparity remains in waitlist time. This forum on US heart allocation policy was organized to discuss these issues and highlight concepts for consideration in the policy development process. A 25-question survey on heart allocation policy was conducted. Among attendees/respondents were 84 participants with clinical/published experience in heart transplant representing 51 US transplant centers, and OPTN/UNOS and SRTR representatives. The survey results and forum discussions demonstrated very strong interest in change to a further-tiered system, accounting for disadvantaged subgroups and lowering use of exceptions. However, a heart allocation score is not yet viable due to the long-term viability of variables (used in the score) in an ever-developing field. There is strong interest in more refined prioritization of patients with MCS complications, highly sensitized patients and those with severe arrhythmias or restrictive physiology. There is also strong interest in distribution by geographic boundaries modified according to population. Differences of opinion exist between small and large centers. The authors provide a summary of the proceedings from a national forum on US heart allocation policy, which recommends a further-tiered allocation system to prioritize disadvantaged subgroups, among other policy changes. See editorial by Barr and Taylor (page 7) and special article by Meyer et al (page 44).

AB - Since the latest revision in US heart allocation policy (2006), the landscape and volume of transplant waitlists have changed considerably. Advances in mechanical circulatory support (MCS) prolong survival, but Status 1A mortality remains high. Several patient subgroups may be disadvantaged by current listing criteria and geographical disparity remains in waitlist time. This forum on US heart allocation policy was organized to discuss these issues and highlight concepts for consideration in the policy development process. A 25-question survey on heart allocation policy was conducted. Among attendees/respondents were 84 participants with clinical/published experience in heart transplant representing 51 US transplant centers, and OPTN/UNOS and SRTR representatives. The survey results and forum discussions demonstrated very strong interest in change to a further-tiered system, accounting for disadvantaged subgroups and lowering use of exceptions. However, a heart allocation score is not yet viable due to the long-term viability of variables (used in the score) in an ever-developing field. There is strong interest in more refined prioritization of patients with MCS complications, highly sensitized patients and those with severe arrhythmias or restrictive physiology. There is also strong interest in distribution by geographic boundaries modified according to population. Differences of opinion exist between small and large centers. The authors provide a summary of the proceedings from a national forum on US heart allocation policy, which recommends a further-tiered allocation system to prioritize disadvantaged subgroups, among other policy changes. See editorial by Barr and Taylor (page 7) and special article by Meyer et al (page 44).

UR - http://www.scopus.com/inward/record.url?scp=84919630679&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84919630679&partnerID=8YFLogxK

U2 - 10.1111/ajt.13033

DO - 10.1111/ajt.13033

M3 - Article

C2 - 25534656

AN - SCOPUS:84919630679

VL - 15

SP - 55

EP - 63

JO - American Journal of Transplantation

JF - American Journal of Transplantation

SN - 1600-6135

IS - 1

ER -