Continuous Distribution of Hearts Update, Summer 2024

At a glance

Background

In December 2018, the OPTN Board of Directors approved the continuous distribution framework for allocation of all organs. Continuous distribution will rank waiting list candidates based on points for various factors, such as medical urgency, candidate biology, patient access, and placement efficiency. Continuous distribution will remove the hard boundaries built into the current framework to increase equity for patients and transparency in the system.

This update builds upon the OPTN Heart Transplantation Committee’s previous work, shares the results from the values prioritization exercise conducted in winter 2024, requests community feedback on the results of the exercise and the attributes being considered for inclusion, and offers next steps for continuous distribution of hearts. test.

Supporting media

Presentation

View presentation

Project update

Values Prioritization Exercise results
- 702 individuals completed the exercise
- The overall weight for each attribute from the exercise:
  - 37.4% medical urgency
  - 23.7% pediatric priority
  - 14.1% prior living donor priority
  - 10.8% biological disadvantage priority (points given to candidates based on blood type or level of sensitization)
  - 6.2% post-transplant survival
  - 4.6% waiting time
  - 3.2% proximity efficiency
Committee continues to discuss the feedback received from the community during the winter 2024 public comment cycle

Anticipated impact

What it's expected to do
- Provide a more equitable approach to matching candidates and donors
- Remove hard boundaries 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 request for feedback is not a proposed policy change, but will help the Heart Transplantation Committee develop a future policy proposal

Terms to know

Attribute: Criteria used to classify then sort and prioritize candidates. For example, in heart allocation, suggested criteria include medical urgency, candidate biology, patient access, and placement efficiency.
Values Prioritization Exercise (VPE): An exercise that asks participants to rate the importance of an attribute when it is compared to another attribute.
Composite Allocation Score: Combines points from multiple attributes together. This request for feedback proposes the use of composite allocation scores in a points-based framework.