The Effects of the New Donor Heart Allocation Policy on Temporary Device Utilization and Outcomes: A Single Center Experience

Purpose The new donor heart allocation policy in United States, which prioritizes the most urgent patients on the waitlist, may affect post-transplant care and outcomes. The objective of this study was to analyze post-transplant outcomes in the period immediately surrounding the implementation of the new allocation policy. Methods We assessed 116 patients undergoing heart transplantation in the six months before and after the change in donor allocation policy on October 18, 2018. Patients transplanted under status 1A before the policy change were compared to patients transplanted under status 1, 2 or 3 after the change. Perioperative mortality, complications, lengths of stay, 6-month and 1-year survival were retrospectively analyzed. Results The total number of heart transplants increased from n=46 prior to the policy change to n=70 after the change. The proportion of patients transplanted under urgent status, however, did not change (78.3% vs. 80%). An increase in ECMO and IABP utilization was noted after the policy change (0% to 10% and 11% to 17%, respectively). Despite the increase in device use, the 1-year survival rates were similar in patients transplanted immediately before and after allocation changes (100% vs 92.7%, p=0.094). No significant differences in ICU or overall hospital lengths of stay were observed. Conclusion Although the proportion of patients transplanted urgently did not change, the use of temporary devices increased after the change in allocation policy. Similar complication rates and survival were noted, suggesting that increased utilization of temporary devices was not associated with worse outcomes.