Meyer D M, Rogers J G, Edwards L B, Callahan E R, Webber S A, Johnson M R, Vega J D, Zucker M J, Cleveland J C
Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
Am J Transplant. 2015 Jan;15(1):44-54. doi: 10.1111/ajt.13030.
Ensuring equitable and fair organ allocation is a central charge of the United Network for Organ Sharing (UNOS) as the Organ Procurement and Transplantation Network (OPTN) through its contract with the Department of Health and Human Services (DHHS). The OPTN/UNOS Board initiated a reassessment of the current allocation system. This paper describes the efforts of the OPTN/UNOS Heart Subcommittee, acting on behalf of the OPTN/UNOS Thoracic Organ Transplantation Committee, to modify the current allocation system. The Subcommittee assessed the limitations of the current three-tiered system, outcomes of patients with status exceptions, emerging ventricular assist device (VAD) population, options for improved geographic sharing and status of potentially disenfranchised groups. They analyzed waiting list and posttransplant mortality rates of a contemporary cohort of patient groups at risk, in collaboration with the Scientific Registry of Transplant Recipients to develop a proposed multi-tiered allocation scheme. This proposal provides a framework for simulation modeling to project whether candidates would have better waitlist survival in the revised allocation system, and whether posttransplant survival would remain stable. The tiers are subject to change, based on further analysis by the Heart Subcommittee and will lead to the development of a more effective and equitable heart allocation system.
作为器官采购与移植网络（OPTN），通过与卫生与公众服务部（DHHS）签订的合同，确保公平公正的器官分配是器官共享联合网络（UNOS）的核心职责。OPTN/UNOS董事会启动了对当前分配系统的重新评估。本文描述了OPTN/UNOS心脏小组委员会代表OPTN/UNOS胸科器官移植委员会为修改当前分配系统所做的努力。该小组委员会评估了当前三层系统的局限性、有特殊情况患者的治疗结果、新兴的心室辅助装置（VAD）人群、改善地理共享的选项以及可能被剥夺权利群体的状况。他们与移植受者科学登记处合作，分析了当代一组高危患者群体的等待名单和移植后死亡率，以制定拟议的多层分配方案。该提案为模拟建模提供了一个框架，以预测候选人在修订后的分配系统中是否会有更好的等待名单生存率，以及移植后生存率是否会保持稳定。这些层级可能会根据心脏小组委员会的进一步分析而改变，并将导致开发出一个更有效、更公平的心脏分配系统。
