Abstract 15812: Assessing the Effect of the Unos Heart Allocation Policy Change on Ohtx and Lvad Access and Outcomes

Abstract

Introduction: In October 2018, the heart allocation policy for adult heart transplant (OHTx) in the United States was changed, with the goal of reducing waitlist mortality and providing broader sharing of donor organs within the United States. The aim of this study was to assess the effect of this policy change on access to OHTx vs LVAD, overall and among key sociodemographic subgroups, in the US from 2016 to 2019. Hypothesis: We hypothesized that the UNOS heart allocation policy would increase OHTx volume overall as well as use of temporary mechanical circulatory support. Methods: We identified all patients receiving OHTx or LVAD between 2016-2019 using the National Inpatient Sample. Controlling for medical comorbidities, trends over time, and within hospital-year effects, we fit a dynamic logistic regression model to evaluate patient and hospital factors associated with receiving OHTx vs LVAD pre- versus post-policy change. Results: We identified 2264 patients who received OHTx and 3157 who received LVADs during the study period. Overall, there was a 4.16% increase in OHTx receipt, compared to LVAD, in the post-period (p=0.006). Among OHTx recipients, the frequency of use of tMCS changed from 15.61% in the pre period to 42.55% in the post period (p-value < 0.0001). While the policy change was associated with differences in the odds of receiving an OHTx versus LVAD between different regions of the country, there were no significant changes based on age, gender, race/ethnicity, insurance status, or rurality. Conclusions: The UNOS policy change on access to OHTx was associated with slightly higher rates of OHTx overall, and higher rates of use of temporary support prior to transplant, but no differential change in access among key demographic groups. Shifts in regional allocation were not significant overall, though certain regions appeared to have a relative increase in their use of OHTx.