Proposed heart allocation rule aims to cut deaths among people on transplant wait list

Luis Fábregas
| Wednesday, Jan. 27, 2016, 5:12 p.m.

Transplant policymakers want to change the way donor hearts are allocated for transplantation, saying new distribution rules could reduce the number of people who die on the waiting list.

A proposal made public this week by the Organ Procurement and Transplantation Network and United Network for Organ Sharing would broaden the geographic regions where candidates get offers for hearts and expand the listing categories that a patient can fall into when listed.

“The goals of our proposal were really to reduce the wait list mortality rates and particularly among the most urgent adult heart transplant candidates,” Dr. Joseph Rogers, chair of the OPTN/UNOS thoracic organ transplantation committee, said Wednesday. The committee is overseeing the proposed rule.

Rogers said the committee was motivated by the desire to identify people at the highest need “for this scarce resource.” More than 4,200 people nationwide are on the heart transplant wait list, according to UNOS data. In 2015, 350 people died while waiting for a heart, data show.

Under the new rules, people waiting for a donor heart would be placed in one of six categories, rather than the existing three, depending on how sick they are. The sickest would get top priority, followed by people who are more stable and possibly still at home.

The sickest would be able to get offers from more donors in broader geographic areas, Rogers said. If a candidate gets sicker while waiting, he or she can move up to a higher-priority category, just as they can under the current allocation system, he said.

Rogers, who is a professor of medicine and interim chair of the division of cardiology at Duke University Medical Center, said the changes would not affect patient survival after transplant surgery.

Two centers in Western Pennsylvania perform heart transplants: UPMC Presbyterian and Allegheny Health Network's Allegheny General Hospital. The centers belong to Region 2, one of 11 geographic regions created by UNOS to facilitate organ allocation. In 2015, centers in Region 2 performed 265 heart transplants.

The proposal is one of nine that UNOS made public on Monday.

UNOS wants people to provide feedback about the proposal and will accept comments on the OPTN website through March 25.

“We encourage any interested person or organization to review these policies and offer their thoughts, whether supporting or opposing the proposal,” said Joel Newman, a UNOS spokesman.

Newman said many proposals undergo substantial revisions before they are approved and implemented. It could take up to a year for the rules to become final.

The proposal applies only to adult transplant candidates, officials said.

It received the endorsement of Jim Gleason, a heart transplant recipient who sits on the OPTN/UNOS board.

“The new rules improve on the fairness of how hearts are allocated, with candidates in most need getting first access,” Gleason said.

Luis Fábregas is the Tribune-Review's medical editor. Reach him at 412-320-7998 or

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