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Overview

Status: Implemented

Sponsoring Committee: Heart Transplantation

Strategic Goal: Improve waitlisted patient, living donor, and transplant recipient outcomes

Contact:

Sara Rose Wells

Documentation

Briefing Paper

Policy Notice

Guidance and Policy Addressing Adult Heart Allocation

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What is current policy and why change it?

In 2018, adult heart allocation policy was changed to better sort candidates based on their medical urgency. The Heart Committee (formerly the Thoracic Committee) monitored the impact of the changes and identified opportunities for improvement. This proposal will provide clearer information for transplant programs submitting exception requests. It also gives improved guidance to regional review board members who evaluate these requests. Additionally, it changes policy to make clear when certain data need to be submitted and provides more consistent timeframes for how long statuses last. The goal is to further clarify current adult heart status criteria.

Guidance and Policy Clarifications Addressing Adult Heart Allocation Policy

Dr. Shelley Hall, Chair of the OPTN Heart Transplantation Committee, reviews the Guidance and Policy Clarifications Addressing Adult Heart Allocation policy proposal.

Terms you need 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.

Click here to search the OPTN glossary

What’s the proposal?

  • Guidance for transplant programs and heart regional review board members
    • Addresses Status 2 adult heart candidates experiencing cardiogenic shock
    • Provides a template for transplant program staff on what information to submit for a Status 2 exception
  • Updates policy
    • Clear deadlines for submitting certain data for Status 4 candidates
    • More consistent timeframes for the length of time a candidate can remain at an approved status

What’s the anticipated impact of this change?

  • What it’s expected to do
    • Help ensure that candidates with similar medical urgency are treated equally
    • Provide transplant programs more information on what they need to include in their exception requests
    • Create more consistency with Review Board decisions on exception requests

Themes to consider

  • What the volume of Status 2 exception requests suggests about adult heart statuses in policy
  • Usefulness of guidance for Status 2 exception requests
  • Appropriateness of proposed timeframes within adult heart statuses

Comments

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