Opinion: Let’s reconsider who gets priority for heart transplants

No one wants to have to decide who gets a life-saving heart transplant and who has to keep waiting, but because the demand for donated hearts far outstrips supply, those choices remain unavoidable.

While current policy favors the sickest patients, we think it’s time to consider whether greater priority should be given to those most likely to live long, healthy lives after transplant.

That’s the main takeaway from a seven-year study we recently published in the journal Productions and Operations Management.

Our research focused on a system overseen by the United Network for Organ Sharing, also called UNOS. The network started using a seven-tier system in 2018 that largely gave priority to the sickest patients, partly to reduce wait times.

Did it work? Certainly not as well as hoped.

Waiting time did not change significantly, and post-transplant survival has stayed almost the same.

To help find a better way, we conducted a mathematical simulation to see what would happen if policy shifted, most notably to maximize “quality-adjusted life years,” a measure of the quality and quantity of life after transplant.

We found that it could be possible to significantly increase post-transplant survival while reducing the overall expected wait time for heart transplants.

Any policy change should be vigorously debated by the medical community, but we know this one would have precedent.

Kidneys used to go to the sickest patients, as hearts do now, but a policy shift about 20 years ago started to place greater emphasis on other factors, including post-transplant survival.

In Europe, several nations have shifted policies to include post-transplant survival in allocating donated hearts. Those nations include France and the members of Eurotransplant, an organization that allocates donor organs in Austria, Belgium, Croatia, Germany, Hungary, Luxembourg, the Netherlands and Slovenia.

Our simulation serves as a good first step, but it has limitations, and we urge more study. A natural next step would be to test our proposed policies with Thoracic Simulation Allocation Modeling.

Now is an ideal time to dig deeper into what a policy change could mean. The Organ Procurement and Transplantation Network’s Heart Committee will soon develop a score-based policy to allocate donated hearts. Our results show that including post-transplant survival may significantly improve the total benefits to society.

We hope that at the very least our simulation will help invigorate debate about heart transplant policies. In the end, everyone wants a system that is fair and just and makes the best use of the precious few hearts available for transplant.

To learn more, you can read our paper, “Is it Time to Include Post-Transplant Survival in Heart Transplantation Allocation Rules?” Click here.



About the authors: Dr. Farhad Hasankhani recently received his Ph.D. in industrial engineering from Clemson University and currently works as an operations research analyst at Norfolk Southern in Atlanta. Dr. Amin Khademi, an associate professor of industrial engineering, was Hasankhani’s Ph.D. advisor.