Amend Status Extension Requirements in Adult Heart Allocation Policy

At a glance

Current policy

In 2018, adult heart allocation policy was changed to better sort candidates based on their medical urgency. Specific medical conditions must be present to qualify for each status and each status is valid for a certain amount of time before new information is required for an extension. Transplant programs have had questions about what specific information is required for patients to stay at their medically urgent status.

Supporting media

Presentation

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Proposed changes

• Clarify when a patient can remain at an assigned status beyond the first qualifying period
• Specify the criteria that must be met for a patient to qualify for a status extension
• Clarify Policy 6.1.C.iv: Mechanical Circulatory Support Device (MCSD) with Pump Thrombosis

Anticipated impact

• What it's expected to do
  • Address gaps and inconsistencies in heart allocation policy
  • Ensures extension requirements are consistent and clear
  • Ensure that similar patients have similar opportunities to receive an organ offer
• What it won't do
  • This proposal does not incorporate the new continuous distribution framework to heart policy
  • This proposal is not a substantive change to heart policy nor the heart allocation system

Themes

• Criteria for extension
• Clarifies extension policy language

Terms to know

• Exception Request: When a candidate does not meet the requirements for a particular status, but their transplant program believes they are at a similar risk of death while waiting for transplant and have a similar potential for benefit after receiving a transplant, they may ask that the candidate be placed at that higher status. These requests are reviewed retrospectively by the review board.
• Medical Urgency: Amount of risk to a candidate’s life or long term health without receiving an organ transplant.
• Mechanical Circulatory Support Device (MCSD): Device that helps pump blood through the body when the heart is not properly working.

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