Critically appraising the 2018 United Network for Organ Sharing donor allocation policy: adding life boats or rearranging the deck chairs?

Journal Article (Review;Journal Article)

Purpose of review

Due 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 findings

The 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.


The 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.

Full Text

Duke Authors

Cited Authors

  • Truby, LK; Farr, M; Topkara, VK

Published Date

  • February 2022

Published In

Volume / Issue

  • 35 / 1

Start / End Page

  • 42 - 47

PubMed ID

  • 34772845

Pubmed Central ID

  • PMC8765708

Electronic International Standard Serial Number (EISSN)

  • 1473-6500

International Standard Serial Number (ISSN)

  • 0952-7907

Digital Object Identifier (DOI)

  • 10.1097/aco.0000000000001077


  • eng