Continuous Distribution of Hearts

At a glance

Background

The concept paper is intended to inform the heart transplantation community about a continuous distribution allocation framework, as well as describe the Heart Transplantation Committee’s initial efforts in transitioning from a classification-based allocation system to a continuous distribution allocation system. The paper provides a general overview of the components of continuous distribution. It also identifies the attributes chosen by the Committee for inclusion in the initial version of heart continuous distribution, and their initial efforts to develop rating scales for prioritizing candidates. The paper requests community feedback that will assist the Heart Transplantation Committee’s work.

Supporting media

General proposal information

Proposal information for patients

Presentation

View presentation

Proposed concept

Continuous distribution will replace the current classification-based allocation system with a points-based allocation system. A points-based framework assigns a composite allocation score to each candidate.
A candidate’s composite allocation score will determine the order that organs are offered to candidates.
A candidate’s composite allocation score will consider a combination of donor and candidate characteristics, which can include candidate medical urgency, post-transplant survival, candidate biology, patient access, and placement efficiency.

Anticipated impact

What it's expected to do
- Provide a more equitable approach to matching candidates and donors
- Remove hard boundaries between classifications that prevent candidates from being prioritized higher on the match run
- Establish a system that is flexible enough to work for each organ type

What it won't do
- This paper is not a proposed policy change, but the feedback gathered will help the Heart Transplantation Committee develop a future policy proposal

Terms to know

Attribute: Attributes are criteria used to classify, sort, and prioritize candidates. For example, in heart allocation attributes can include blood type compatibility, mechanical support, heart failure therapies, and distance between candidate and donor hospitals.
Composite Allocation Score: A composite allocation score combines points from multiple attributes together. This concept paper proposes the use of composite allocation scores in a points-based framework.
Rating Scale: A rating scale describes how much preference is given to candidates within each attribute.
Weights: Weights reflect the relative importance or priority of each attribute in the overall composite allocation score. Combined with the ratings scale and each candidate’s information, this results in an overall composite score for prioritizing candidates.