Organ Allocation and Prioritization

The impetus for change of the prior heart allocation system by the Board of United Organ Sharing Network (UNOS) was the persistently high waiting list mortality in the highest-acuity patients and the almost tripling of new patients added to the waiting list since 2005. Once the Heart Subcommittee of the UNOS Thoracic Committee concluded that change was needed in the current system, the discussion focused on the limitations of the current system and how it did not meet the demands of the contemporary patient population. The three-tiered system was considered urgency-based, but it was the candidate’s accrued time in the particular status, within the candidate’s geographic zone, that served as the primary driver of organ allocation. Straw Man tiers served as the basis for the Thoracic Simulation Allocation Modeling analysis. The public comment period brought up many of the controversies that the Heart Subcommittee debated in internal discussions.