Original Clinical ScienceUse of exception status listing and related outcomes during two heart allocation policy periods
Section snippets
Study cohort
This study used data from the Scientific Registry of Transplant Recipients (SRTR). The SRTR data system includes data on all donors, waitlisted candidates, and transplant recipients in the United States submitted by the members of OPTN and has been described elsewhere.5 The Health Resources and Services Administration, U.S. Department of Health and Human Services, provides oversight of the activities of the OPTN and SRTR contractors.
The analysis was limited to adults (18 years or older) listed
Baseline characteristics of waitlisted patients
From November 1, 2015, to September 30, 2021, 19,213 adult patients were listed for heart transplantation. Of these, 9,624 (49.9%) candidates were listed during the prepolicy period and 9,589 (50.1%) during the postpolicy period. At the time of initial listing, 328 (3.4%) candidates were listed by exception status during the prepolicy period compared to 1,704 (17.8%) candidates listed by exception status during the postpolicy period, a more than 5-fold increase (Figure 1, Table 1). The increase
Discussion
The current study evaluates the impact of the October 2018 change to the heart allocation policy on exception status listings and waitlist outcomes for patients listed by exception. Unlike previous work, our analyses allowed medical urgency and exception statuses to change over time and estimated the effect of exception status listing at each level of medical urgency. We found a dramatic 5.2 times increase in exception status listings following the policy change, with 32.2% of all candidates
Disclosure statement
Golbus receives funding from the National Institutes of Health (NIH; L30HL143700) and receives salary support from an American Heart Association (AHA) grant (20SFRN35370008). Nallamothu is a principal investigator or co-investigator on research grants from the NIH, Veterans Affairs Health Services Research and Development Service, the AHA, and Janssen and receives compensation as the Editor-in-Chief of Circulation: Cardiovascular Quality and Outcomes, a journal of the AHA. Colvin is an
Funding
None.
CRediT authorship contribution statement
All authors take responsibility for the content of the manuscript. All authors contributed to the conceptualization of the work and study design. Lyden and Ahn performed the analyses under the supervision of Israni and Zaun. The first draft of the manuscript was prepared by Golbus. It was reviewed and edited by all authors, all of whom made the decision to submit the manuscript.
Acknowledgments
This work was conducted under the auspices of the Hennepin Healthcare Research Institute (HHRI), contractor for the Scientific Registry of Transplant Recipients (SRTR), as a deliverable under contract no. 75R60220C00011 (U.S. Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, and Division of Transplantation). The U.S. Government (and others acting on its behalf) retains a paid-up, nonexclusive, irrevocable, worldwide license for all
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Cited by (2)
Best practices for statistical analysis of pretransplant medical urgency
2024, Journal of Heart and Lung TransplantationOPTN/SRTR 2022 Annual Data Report: Heart
2024, American Journal of Transplantation
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