Health Services/Population Health

29. The Association of the UNOS Heart Allocation Policy Change with Transplant and Left Ventricular Assist Device Access and Outcomes

Introduction: In October 2018, the allocation policy for adult orthotopic heart transplant (OHTx) in the United States was changed, with the goal of reducing waitlist mortality and providing broader sharing of donor organs within the United States. The aim of this study was to assess the association of this policy change with changes in access to OHTx vs left ventricular assist devices (LVADs), overall and among key sociodemographic subgroups, in the US from 2016 to 2019.

Methods: We identified all patients receiving OHTx or LVAD between 2016-2019 using the National Inpatient Sample. Controlling for medical comorbidities, pre-policy trends, and within hospital-year effects, we fit a dynamic logistic regression model to evaluate patient and hospital factors associated with receiving OHTx vs LVAD pre- versus post-policy change. We also examined the frequency of temporary mechanical circulatory support (tMCS) in the same fashion.

Results: We identified 2264 patients who received OHTx and 3157 who received LVADs during the study period. In its first year of implementation, the UNOS policy change of 2018 was associated with no overall change utilization of OHTx vs LVAD. Among OHTx recipients, the frequency of use of tMCS changed from 15.6% in the pre period to 42.6% in the post period (p<0.001). While the policy change was associated with differences in the odds of receiving an OHTx versus LVAD between different regions of the country, there were no significant changes based on age, gender, race/ethnicity, insurance status, or rurality.

Impact: The UNOS policy change on access to OHTx was associated with no overall change in OHTx vs LVAD use in its first year of implementation although we observed small changes in relative odds of transplant based on rurality.  Shifts in regional allocation were not significant overall, though certain regions appeared to have a relative increase in their use of OHTx.

OrganizationWashington University in St. Louis

Fox DK, Waken RJ. Wang F, Wolfe JD, Robbins K, Fanous E, Vader J, Schilling J, Maddox KE