The Heart Transplant Waiting List and the Interplay of Policy and Practice
In Search of Fairness
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See Article by Parker et al
The national heart allograft allocation algorithm established by the Organ Procurement and Transplantation Network has undergone several major changes over the years. The main goals of these policy modifications have been to respond to the evolving treatment options for advanced heart failure patients, minimize the risk of death on the waiting list, and maximize the benefit of transplant.1 An aspirational goal has also been to achieve as much uniformity as possible in the practical application of the allocation algorithm.
Every modification of the allocation policy in the past has been met with a good dose of anxiety in anticipation of what the implemented change will mean. Will the benefits to transplant candidates predicted by the statistical modeling of waiting list events be realized? Will the change affect the required level of staffing or the established process logistics of organizations participating in donation, procurement, and transplantation? Will the change alter transplant volumes at one’s transplant center? Yet, the more contentious aspect has typically been the issue of uniform application of the policy from one transplant program to another and from patient to patient—a subject matter that can be best characterized as fairness.
In this issue of Circulation: Heart Failure, Parker et al2 present their evaluation of one aspect of the fairness of the current heart allocation in the United States. They hypothesized that changes have taken place over time in the listing practices under the current Organ Procurement and Transplantation Network allocation …