Heart transplantation equitable distribution of donor hearts: Difference between revisions

Jump to navigation Jump to search
(Created page with "'''Editor(s)-in-Chief:''' C. Michael Gibson, M.S., M.D.; '''Associate Editor-In-Chief:''' {{CZ}} ==Equitable Distribution of Donor Hearts to those Awaiting Transplantati...")
 
 
(15 intermediate revisions by 3 users not shown)
Line 1: Line 1:
'''Editor(s)-in-Chief:''' [[C. Michael  Gibson, M.S., M.D.]]; '''Associate Editor-In-Chief:''' {{CZ}}
__NOTOC__
{{Heart transplantation}}
 
'''Editor(s)-in-Chief:''' [[C. Michael  Gibson, M.S., M.D.]]; '''Associate Editor-In-Chief:''' {{CZ}}{{IF}}


==Equitable Distribution of Donor Hearts to those Awaiting Transplantation and the Process of Being Listed for a Transplant==
==Equitable Distribution of Donor Hearts to those Awaiting Transplantation and the Process of Being Listed for a Transplant==
In order to assure that access to donor hearts is equitably distributed, the United Network for Organ Sharing (UNOS), was created.  In general, patients who are hospitalized and require ongoing administration of parenteral [[inotropic]] agents are at highest risk of death, and are placed at the highest priority on the list of potential recipients. The following factors are used in assigning the priority for transplantation:
*In order to assure that access to donor hearts is equitably distributed, the '''''[https://unos.org/ United Network for Organ Sharing] (UNOS)''''', was created.  In general, patients who are hospitalized and require ongoing administration of parenteral [[inotropic]] agents are at highest risk of death, and are placed at the highest priority on the list of potential recipients.
*The level of acuity of the patient's condition (sicker patients are higher on the list)
 
*The time the patient has waited on the list (patients who have waited longer are higher on the list)
*The following factors are used in '''''assigning the priority''''' for transplantation:
*Duration of ischemic time anticipated when a donor heart does become available (assessed in increments of 500 miles between donor and recipient hospitals)(patients who are located closer to the donor heart are higher on the list)
:*The level of acuity of the patient's condition (sicker patients are higher on the list)
:*The time the patient has waited on the list (patients who have waited longer are higher on the list)
:*Duration of ischemic time anticipated when a donor heart does become available (assessed in increments of 500 miles between donor and recipient hospitals)(patients who are located closer to the donor heart are higher on the list) <ref name="pmid3539399">{{cite journal| author=Robertson JA| title=Supply and distribution of hearts for transplantation: legal, ethical, and policy issues. | journal=Circulation | year= 1987 | volume= 75 | issue= 1 | pages= 77-87 | pmid=3539399 | doi=10.1161/01.cir.75.1.77 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3539399  }} </ref>


Some patients may be moved down the list or they may be taken off of the list (delisted). About 5% of patients are delisted because they improve with medical therapy. The prognosis of patients who have been delisted is controversial. The largest study to date of 100 patients indicates that delisted patients may have a slightly poorer long-term prognosis than those patients who are transplanted. <ref name="pmid18455599">{{cite journal |author=Hoercher KJ, Nowicki ER, Blackstone EH, Singh G, Alster JM, Gonzalez-Stawinski GV, Starling RC, Young JB, Smedira NG |title=Prognosis of patients removed from a transplant waiting list for medical improvement: implications for organ allocation and transplantation for status 2 patients |journal=[[The Journal of Thoracic and Cardiovascular Surgery]] |volume=135 |issue=5 |pages=1159–66 |year=2008 |month=May |pmid=18455599 |doi=10.1016/j.jtcvs.2008.01.017 |url=http://linkinghub.elsevier.com/retrieve/pii/S0022-5223(08)00168-2 |issn=}}</ref> While early survival was better among those patients who were delisted, survival after 30 months tended to be better among patients who were transplanted. Among delisted patients, the mean duration of survival was 7.7 years, and 94%, 55% and 28% of patients were event-free at 1, 5, and 10 years respectively.  Although data is lacking, it has been hypothesized that survival could be further improved among delisted patients to 45% at 10 years if a [[defibrillator]] or [[AICD]] was implanted.
Later, UNOS adopted a policy known as the "final rule" ({{cite web |url=https://optn.transplant.hrsa.gov/governance/public-comment/frameworks-for-organ-distribution/ |title=Frameworks for Organ Distribution - OPTN |format= |work= |accessdate=}}) mandating that organ donors should be allocated to the sickest candidates such that acuity of care takes precedence over geographic factors. <ref name="pmid30311153">{{cite journal| author=Khalili M, Wong RJ| title=Underserved Does Not Mean Undeserved: Unfurling the HCV Care in the Safety Net. | journal=Dig Dis Sci | year= 2018 | volume= 63 | issue= 12 | pages= 3250-3252 | pmid=30311153 | doi=10.1007/s10620-018-5316-9 | pmc=6436636 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30311153  }} </ref>  


The predictors of death within two months of being placed on a transplant list among status 1 candidates include <ref>Lietz, K, Miller, LW. Improved survival of patients with end-stage heart failure listed for heart transplantation: analysis of organ procurement and transplantation network/U.S. United Network of Organ Sharing data, 1990 to 2005. J Am Coll Cardiol 2007; 50:1282.</ref>:
*Some patients may be moved down the list or they may be taken off of the list ('''''delisted'''''). About 5% of patients are delisted because they improve with medical therapy. 
#[[Inotropic]] and [[intra-aortic balloon pump]] support
The prognosis of patients who have been delisted is controversial. The largest study to date of 100 patients indicates that delisted patients may have a slightly poorer long-term prognosis than those patients who are transplanted. While early survival was better among those patients who were delisted, survival after 30 months tended to be better among patients who were transplanted. Although data is lacking, it has been hypothesized that survival could be further improved among delisted patients to 45% at 10 years if a [[defibrillator]] or [[AICD]] was implanted.  <ref name="pmid18455599">{{cite journal |author=Hoercher KJ, Nowicki ER, Blackstone EH, Singh G, Alster JM, Gonzalez-Stawinski GV, Starling RC, Young JB, Smedira NG |title=Prognosis of patients removed from a transplant waiting list for medical improvement: implications for organ allocation and transplantation for status 2 patients |journal=[[The Journal of Thoracic and Cardiovascular Surgery]] |volume=135 |issue=5 |pages=1159–66 |year=2008 |month=May |pmid=18455599 |doi=10.1016/j.jtcvs.2008.01.017 |url=http://linkinghub.elsevier.com/retrieve/pii/S0022-5223(08)00168-2 |issn=}}</ref>  
#[[Pulmonary capillary wedge pressure]] >20 mm Hg
# UNOS status 1A
#[[Mechanical ventilation]]
#Serum [[creatinine]] >1.5 mg/dl
#Failed [[cardiac transplant]]
#Valvular [[cardiomyopathy]]
#Age >60 years
#Caucasian ethnicity
#Weight ≤70 kg
#Lack of an [[AICD]] on the day of listing


The mortality among children and young adults < 18 years of age who are awaiting transplant was 17% between 1999 and 2006 and is higher than adults. The majority of the deaths occurred in those children who weighed 10-15 Kg.
* Survival of patient's on the transplant list has significantly improved. Urgent cardiac transplant is still an important factor for the survival of UNOS status 1 cadidates.
* Some factors that predict death in the first two months of being placed on a transplant list include- <ref name="pmid17888847">{{cite journal| author=Lietz K, Miller LW| title=Improved survival of patients with end-stage heart failure listed for heart transplantation: analysis of organ procurement and transplantation network/U.S. United Network of Organ Sharing data, 1990 to 2005. | journal=J Am Coll Cardiol | year= 2007 | volume= 50 | issue= 13 | pages= 1282-90 | pmid=17888847 | doi=10.1016/j.jacc.2007.04.099 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17888847  }} </ref> <ref name="pmid29664407">{{cite journal| author=Sridharan L, Wayda B, Truby LK, Latif F, Restaino S, Takeda K | display-authors=etal| title=Mechanical Circulatory Support Device Utilization and Heart Transplant Waitlist Outcomes in Patients With Restrictive and Hypertrophic Cardiomyopathy. | journal=Circ Heart Fail | year= 2018 | volume= 11 | issue= 3 | pages= e004665 | pmid=29664407 | doi=10.1161/CIRCHEARTFAILURE.117.004665 | pmc=5905429 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29664407  }} </ref>
**[[Inotropic]] and [[intra-aortic balloon pump]] support
**[[Pulmonary capillary wedge pressure]] greater than 20 mm Hg
** UNOS status 1A
** Patient on [[Mechanical ventilation]]
** Raised serum [[creatinine]] >1.5 mg/dl
** Failure of [[cardiac transplant]]
** Valvular [[cardiomyopathy]]
** Age >60 years
** Caucasian ethnicity
** Weight ≤70 kg
** Lack of an [[AICD]] on the day of listing


==References==
==References==

Latest revision as of 17:54, 21 July 2020

Heart transplantation Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Epidemiology and Demographics

Risk Factors

Screening

Complications and Prognosis

Diagnosis

Indications

Evaluation

Contraindications

Criteria for Cardiac Transplantation

Equitable Distribution of Donor Hearts to those Awaiting Transplantation and the Process of Being Listed for a Transplant

Treatment

Medical Therapy

Surgery

Follow-Up

Electrocardiogram and Pacing After Cardiac Transplantation

Heart transplantation equitable distribution of donor hearts On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Heart transplantation equitable distribution of donor hearts

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Heart transplantation equitable distribution of donor hearts

CDC onHeart transplantation equitable distribution of donor hearts

Heart transplantation equitable distribution of donor hearts in the news

Blogs on Heart transplantation equitable distribution of donor hearts

Directions to Hospitals Treating Heart transplantation

Risk calculators and risk factors for Heart transplantation equitable distribution of donor hearts

Editor(s)-in-Chief: C. Michael Gibson, M.S., M.D.; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [1]Ifrah Fatima, M.B.B.S[2]

Equitable Distribution of Donor Hearts to those Awaiting Transplantation and the Process of Being Listed for a Transplant

  • In order to assure that access to donor hearts is equitably distributed, the United Network for Organ Sharing (UNOS), was created. In general, patients who are hospitalized and require ongoing administration of parenteral inotropic agents are at highest risk of death, and are placed at the highest priority on the list of potential recipients.
  • The following factors are used in assigning the priority for transplantation:
  • The level of acuity of the patient's condition (sicker patients are higher on the list)
  • The time the patient has waited on the list (patients who have waited longer are higher on the list)
  • Duration of ischemic time anticipated when a donor heart does become available (assessed in increments of 500 miles between donor and recipient hospitals)(patients who are located closer to the donor heart are higher on the list) [1]

Later, UNOS adopted a policy known as the "final rule" ("Frameworks for Organ Distribution - OPTN".) mandating that organ donors should be allocated to the sickest candidates such that acuity of care takes precedence over geographic factors. [2]

  • Some patients may be moved down the list or they may be taken off of the list (delisted). About 5% of patients are delisted because they improve with medical therapy.

The prognosis of patients who have been delisted is controversial. The largest study to date of 100 patients indicates that delisted patients may have a slightly poorer long-term prognosis than those patients who are transplanted. While early survival was better among those patients who were delisted, survival after 30 months tended to be better among patients who were transplanted. Although data is lacking, it has been hypothesized that survival could be further improved among delisted patients to 45% at 10 years if a defibrillator or AICD was implanted. [3]

References

  1. Robertson JA (1987). "Supply and distribution of hearts for transplantation: legal, ethical, and policy issues". Circulation. 75 (1): 77–87. doi:10.1161/01.cir.75.1.77. PMID 3539399.
  2. Khalili M, Wong RJ (2018). "Underserved Does Not Mean Undeserved: Unfurling the HCV Care in the Safety Net". Dig Dis Sci. 63 (12): 3250–3252. doi:10.1007/s10620-018-5316-9. PMC 6436636. PMID 30311153.
  3. Hoercher KJ, Nowicki ER, Blackstone EH, Singh G, Alster JM, Gonzalez-Stawinski GV, Starling RC, Young JB, Smedira NG (2008). "Prognosis of patients removed from a transplant waiting list for medical improvement: implications for organ allocation and transplantation for status 2 patients". The Journal of Thoracic and Cardiovascular Surgery. 135 (5): 1159–66. doi:10.1016/j.jtcvs.2008.01.017. PMID 18455599. Unknown parameter |month= ignored (help)
  4. Lietz K, Miller LW (2007). "Improved survival of patients with end-stage heart failure listed for heart transplantation: analysis of organ procurement and transplantation network/U.S. United Network of Organ Sharing data, 1990 to 2005". J Am Coll Cardiol. 50 (13): 1282–90. doi:10.1016/j.jacc.2007.04.099. PMID 17888847.
  5. Sridharan L, Wayda B, Truby LK, Latif F, Restaino S, Takeda K; et al. (2018). "Mechanical Circulatory Support Device Utilization and Heart Transplant Waitlist Outcomes in Patients With Restrictive and Hypertrophic Cardiomyopathy". Circ Heart Fail. 11 (3): e004665. doi:10.1161/CIRCHEARTFAILURE.117.004665. PMC 5905429. PMID 29664407.


Template:WikiDoc Sources