Lim Hoong Sern, Damman Kevin, Baudry Guillaume, Cikes Maja, Adamopoulos Stamatis, Ben-Gal Tuvia, Girerd Nicolas, Zuckermann Andreas, Masetti Marco, Nalbantgil Sanem, Tops Laurens, Ponikowski Piotr, Crespo-Leiro Maria, Ruschitzka Frank, Metra Marco, Gustafsson Finn
University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK.
Eur J Heart Fail. 2025 May 7. doi: 10.1002/ejhf.3681.
Heart transplantation remains the gold standard for treatment of most patients with advanced heart failure (HF), but despite improvements of organ recovery and utilization, donor heart scarcity remains a critically limiting factor. Detailed heart allocation systems (HASs) are in place to ensure use of organs for appropriate candidates, In Europe multiple, different HASs have evolved in different countries or communities of collaborating countries, like Eurotransplant or Scandiatransplant. In this scientific statement, we review the generic ethical and practical principles underlying allocation principles and examine and describe different European HASs with the purpose of discussing impact of outcomes for patients with advanced HF. It is shown that European HASs differ significantly with respect to which patients are prioritized and the methods by which the prioritization is performed. It is argued that the most commonly used parameter to describe success of a HAS, namely 1-year survival after heart transplantation, is a poor metric of HAS performance. The impact of HASs should be evaluated by several measures such as survival from listing, time to transplantation, the characteristics of patients undergoing heart transplantation, and over a longer time interval to understand the balance of early and late post-transplant risks and benefit. Mapping European HASs is a step towards understanding these factors and further research should determine the optimal HAS in a given HF population at a given time.
心脏移植仍然是大多数晚期心力衰竭（HF）患者治疗的金标准，但尽管器官回收和利用有所改善，供体心脏短缺仍然是一个关键限制因素。详细的心脏分配系统（HAS）已到位，以确保器官用于合适的候选者。在欧洲，不同国家或合作国家的社区已经发展出多种不同的HAS，如欧洲移植协会（Eurotransplant）或斯堪的纳维亚移植协会（Scandiatransplant）。在本科学声明中，我们回顾了分配原则背后的一般伦理和实践原则，并检查和描述了不同的欧洲HAS，目的是讨论其对晚期HF患者结局的影响。结果表明，欧洲的HAS在优先考虑哪些患者以及进行优先排序的方法方面存在显著差异。有人认为，描述HAS成功的最常用参数，即心脏移植后的1年生存率，是衡量HAS性能的一个不佳指标。HAS的影响应该通过多种措施来评估，如从列入名单到移植的存活情况、移植时间、接受心脏移植患者的特征，以及在更长的时间间隔内，以了解移植后早期和晚期风险与益处的平衡。绘制欧洲HAS图谱是理解这些因素的第一步，进一步的研究应该确定在给定时间给定HF人群中的最佳HAS。
