The 2018 adult heart allocation policy change benefits low-volume transplant centers

Samuel T. Kim, Zachary Tran, Yu Xia, Joseph Hadaya, Catherine G. Williamson, Matthew Gandjian, Chun Woo Choi, Peyman Benharash

Research output: Contribution to journalArticlepeer-review


Introduction: The effect of the 2018 adult heart allocation policy change at an institution-level remains unclear. The present study assessed the impact of the policy change by transplant center volume. Methods: The United Network for Organ Sharing database was queried for all adults undergoing isolated heart transplantation from November 2016 to September 2020. Era 1 was defined as the period before the policy change and Era 2 afterwards. Hospitals were divided into low-(LVC) medium-(MVC) and high-volume (HVC) tertiles based on annual transplant center volume. Competing-risks regressions were used to determine changes in waitlist death/deterioration, while post-transplant mortality was assessed using multivariable Cox proportional-hazards models. Results: A total of 3531 (47.0%) patients underwent heart transplantation in Era 1 and 3988 (53.0%) in Era 2. At LVC, Era 2 patients were less likely to experience death/deterioration on the waitlist (subhazard ratio.74, 95% CI.63–.88), while MVC and HVC patients experienced similar waitlist death/deterioration across eras. After adjustment, transplantation in Era 2 was associated with worse 1-year mortality at MVC (hazard ratio, HR, 1.42 95% CI 1.02–1.96) and HVC (HR 1.42, 95% CI 1.02–1.98) but not at LVC. Conclusion: Early analysis shows that LVC may be benefitting under the new allocation scheme.

Original languageEnglish (US)
Article numbere14389
JournalClinical Transplantation
Issue number8
StatePublished - Aug 2021


  • Organ Procurement and Transplantation Network (OPTN)
  • United Network for Organ Sharing (UNOS)
  • heart failure/injury
  • organ allocation

ASJC Scopus subject areas

  • Transplantation


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