New Methods of Allocating Heart Transplants

Allocating Heart Transplants

The Bio medicine Agency has set up with All the Transplant Teams New Methods of Allocating Heart Transplants. These new graft allocation methods were implemented on January 2, 2018. They Fundamentally Change the Way of distributing grafts. These new methods place all candidates on the waiting list, take into account the risk of death on the list and aim to improve the match between the donor and the recipient.

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Terms of Allocation of Grafts Before 2018

Heart Transplants Are Still A Limited Resource. There Is Still A Shortage Of Heart Transplants With According To Data From The Bio medicine Agency 1.9 Patients Waiting For A Heart Transplant (1). According To Bioethics Laws, The Distribution Of Grafts Must Be Fair, Efficient, Transparent, And Take Into Account Any Logistical Constraints.

Until January 1, 2018, distributing of grafts was according to two principles (2, 3).

There were three national graft allocation priorities (Super emergency 1, 2, 3) implemented in 2004. They aimed to reduce the number of deaths of patients on the waiting list and the number of discharges for aggravation.

The main priority, which was requested, was Super emergency 1 (SU1). It was established based on patient management criteria. Hospitalization in an ICU needs to use an inotropic infusion or short-term circulatory assistance. Super emergency 2 (SU2) corresponded to an infection or a long-term assistive dysfunction, and super emergency 3 (SU3) compared to a patient with a stabilized total artificial heart.

The assessment of the distribution rules made by the Bio medicine Agency showed:

– The criterion for assigning a national priority of SU1 did not distinguish the severity of patients. Indeed, a quarter of patients in SU1 were at low risk of death, and, conversely, 1/3 of patients at high risk of death were not in SU1.

ED patients had a very high access rate to the transplant compared to patients’ access rates without national priority.

– Matching between donor and recipient could not be adequate in the context of a local allocation, the number of candidates on the waiting list in most centers, by blood group, being too small.

In this context, new rules for allocating grafts were decided to put four based on five criteria.

New attribution rules

  • Firstly, a ranking of all candidates on the waiting list with a national heart transplant award (SNAGC).
  • They allocate the grafts according to objective emergency criteria (risk of death on the list).
  • Taking into account the risk of death after transplant.
  • A match between the donor and the recipient.
  • Replacement of the traditional geographic model of graft allocation by a gravity model considers the travel time between the site of collection and grafting to control ischemia time.
  • Calculation of the national heart transplant allocation score (SNAGC).

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