The 2018 U.S. heart allocation policy change has resulted in an increased survival benefit of heart transplantation due to improved stratification and prioritization of transplant candidates, according to a study published July 7 in JACC: Heart Failure.

Stratton B. Tolmie, BA, et al., investigated the association between the 2018 policy change, which was implemented to increase heart transplantation in the most medically urgent candidates, and survival benefit. They included 23,043 adult heart transplant candidates from 111 centers, with 11,022 candidates comprising the pre-policy cohort (October 2013 to October 2016) and 12,021 candidates in the post-policy cohort (October 2018 to October 2021).

The primary outcome was the survival benefit of transplantation, quantified as the increase in average days alive within three years post procedure. The authors found that the average three-year survival benefit was higher after the policy change, increasing from 217.1 days to 241.2 days per donor heart (p<0.001), and among the highest priority transplant candidates, absolute three-year survival benefit more than doubled from 327.8 days pre-policy change to 699.8 days post-policy change (p<0.001).

In addition, the authors' analysis attributes an overall 1,645 life-years saved from transplantation to the 2018 policy change (4,259 vs. 5,904; p<0.001).

"Overall, our results suggest that the policy has resulted in better sorting of the most clinically acute patients into the highest status, achieving the policy goal of better ranking candidates from 'most to least medically urgent,'" write the authors. "In addition to better sorting of patients by acuity, our results demonstrate other positive changes associated with the 2018 policy change, including a higher number of transplants being performed, a higher percentage of candidates receiving transplants, and a decrease in average time to transplantation."