• Lauren K Truby, Maryjane Farr, and Veli K Topkara.
• Duke Molecular Physiology Institute, Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
• Curr Opin Anaesthesiol. 2022 Feb 1; 35 (1): 424742-47.

Purpose Of ReviewDue to the growing mismatch between donor supply and demand as well as unacceptably high transplant waitlist mortality, the heart organ allocation system was revised in October 2018. This review gives an overview of the changes in the new heart organ allocation system and its impact on heart transplant practice and outcomes in the United States.Recent FindingsThe 2018 heart allocation system offers a 6-tiered policy and therefore prioritizes the sickest patients on the transplant waitlist. Patients supported with temporary mechanical circulatory support devices are prioritized as Status 1 or Status 2, resulting in increased utilization of this strategy. Patients supported with durable left ventricular assist devices have been prioritized as Status 3 or 4, which has resulted in decreased utilization of this strategy. Broader geographic sharing in the new heart allocation system has resulted in prolonged donor ischemic times. Overall, the new heart allocation system has resulted in significantly lower candidate waitlist mortality, shorter waitlist times, and higher incidence of transplantation.SummaryThe new United Network for Organ Sharing allocation policy confers significant advantages over the prior algorithm, allowing for decreased waitlist times and improved waitlist mortality without major impact on posttransplant survival.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

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