Changes in United States heart allocation: A community energized to improve policy

Donor heart allocation in the United States has not evolved in concert with changes in the characteristics of patients on the waiting list or evolution in technology. Data showing the growing population of patients with advanced heart failure coupled with the relatively fixed number of cardiac donors and regional access disparities motivated the United Network for Organ Sharing (UNOS) Thoracic Committee to reexamine candidate prioritization and broader organ sharing. The resultant proposed policy change stratifies patients in a more granular manner based primarily on wait-list mortality and is designed to expand the geographic boundaries to permit greater access to donor hearts for the most critically ill patients awaiting transplant.