For a study, the researchers sought to assess transplant rates at the center level following a recent change in heart transplant allocation policy. The cohort study used data from the United Network for Organ Sharing database to conduct a countrywide examination of transplant centers in the United States from October 18, 2015, to March 1, 2020. Transplant candidates were divided into 2-time cohorts, with era 1 signifying the 3-year period preceding the policy change (October 18, 2018) and era 2 denoting the 500-day period following the policy change but before the COVID-19 pandemic began. From May through June 2021, data were evaluated. On October 18, 2018, a policy change regarding heart allocation became effective. The period 2 group consisted of 5,063 transplant candidates (median [IQR] age, 56 [45-63] years; 1,385 women [27.4%]) out of a total of 15,940. Between eras 1 and 2, the proportion of patients receiving temporary mechanical circulatory assistance increased (extracorporeal membrane oxygenation, 2.00% vs 3.42%; percutaneous ventricular assist device, 0.66% vs 1.86%; intra-aortic balloon pump, 5.21% vs 13.10%). After the rule change, the adjusted mean center-level likelihood of transplant increased (from 48.1% in era 1 to 78.0% in era 2). There was significant heterogeneity in transplant rates among regions and states, even among centers with shared organ procurement organizations. The absolute difference in transplant rates between 2 facilities affiliated with the same organ procurement organization was 27.1%. In period 2, centers with higher transplant volumes and a higher proportion of candidates having an intra-aortic balloon pump had higher transplant rates. The outcomes implied that intercepter differences in the chance of transplant have persisted following the heart allocation policy modification, despite organ availability and minimal geographical distance. More research was needed to ensure that organs were distributed fairly in heart transplants.
Source:jamanetwork.com/journals/jamacardiology/article-abstract/2787706
