Trends in US Heart Transplant Waitlist Activity and Volume During the Coronavirus Disease 2019 (COVID-19) Pandemic

This cross-sectional study describes national and regional trends in waitlist inactivations, waitlist additions, donor recovery, and heart transplant volume during the coronavirus disease 2019 (COVID-19) pandemic. Importance Solid organ transplants have declined significantly during the coronavirus disease (COVID-19) pandemic in the US. Limited data exist regarding changes in heart transplant (HT). Objective To describe national and regional trends in waitlist inactivations, waitlist additions, donor recovery, and HT volume during COVID-19. Design, Setting, and Participants This descriptive cross-sectional study used publicly available data from the United Network for Organ Sharing and US Centers for Disease Control and Prevention, using 8 prespecified United Network for Organ Sharing regions. Adult (18 years or older) HT candidates listed and deceased donors recovered between January 19 to May 9, 2020. Exposures COVID-19 pandemic. Main Outcomes and Measures Changes in waitlist inactivations, waitlist additions, deceased donor recovery, and transplant volumes from the pre-COVID-19 (January 19-March 15, 2020) to the COVID-19 era (March 15-May 9, 2020). Density mapping and linear regression with interrupted time series analysis were used to characterize changes over time and changes by region. Results During the COVID-19 era, there were 600 waitlist inactivations compared with 343 during the pre-COVID era (75% increase). Waitlist additions decreased from 637 to 395 (37% reduction). These changes were most profound in the Northeast and Great Lakes regions with high rates of COVID-19. Deceased donor recovery decreased by 26% from 1878 to 1395; the most significant decrease occurred in the North Midwest despite low COVID-19 prevalence. Heart transplant volumes were significantly reduced across all regions except the Northwest. The largest decrease was seen in the Northeast where COVID-19 case rates were highest. From the pre-COVID-19 era to the COVID-19 era, there was significant regional variation in waitlist additions (eg, 69% decrease in the Northeast vs 8.5% increase in the South Midwest; P < .001) and deceased donor recovery (eg, 41% decrease in North Midwest vs 16% decrease in South Midwest; P = .02). Conclusions and Relevance Heart transplant volumes have been significantly reduced in recent months, even in regions with a lower prevalence of COVID-19 cases. This has been accompanied by increased waitlist inactivations, decreased waitlist additions, and decreased donor recovery. Future studies are needed to determine if the COVID-19 pandemic is associated with changes in waitlist mortality. Question How have heart transplant listings and volumes in the US changed during the coronavirus disease 2019 (COVID-19) pandemic? Findings In this cross-sectional analysis of heart transplant data from the United Network for Organ Sharing and the US Centers for Disease Control and Prevention, compared with the pre-COVID-19 era, the total number of waitlist inactivations has increased while new waitlist additions, deceased donor recoveries, and heart transplants have decreased across the US. During the COVID-19 era, there was significant regional variation in these practices. Meaning Further studies are needed to determine the long-term associations between these trends and waitlist and posttransplant outcomes.