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Time to Transplant


                                                                                  Heart Transplantation: Version 7.0

Time to Transplant

Hearts are allocated according to the patient’s clinical status.  Patients are categorized by the severity of their illness and other factors that predict mortality while on the waiting list, including: clinical judgment, hospitalization status, need for life support, use of mechanical support devices, complications of mechanical support devices, and a requirement for continuous inotropic support and at what level. Pediatric and adult listing criteria are different. The following listing criteria are used:

Clinical Status Adult

Listing Criteria

1A

    Hospitalized with at least one of the following: (valid for 30 days)

1A

    1) Mechanical circulatory support for acute hemodynamic
        decompensation

            a)LVAD and/or RVAD

            b)Total artificial heart

            c)Intra-aortic balloon pump

            d)ECMO

1A

    2) Mechanical circulatory support with device related complications
        (valid for 14 days)

1A

    3) Mechanical ventilation

1A

    4) Continuous infusion of single high-dose inotrope, or multiple IV
         inotropes, in addition to continuous hemodynamic monitoring of
         LV filling pressures

1A

    5) None of the above, but a life expectancy without heart
         transplant < seven days

1B

    At least one of the following devices or therapies in place:

1B

    1) LVAD and/or RVAD implanted

1B

    2) Continuous infusion of IV inotropes

2

    Patient does not meet the criteria for 1A or 1B

7

    Patient is considered temporarily unsuitable to receive a thoracic
    organ transplant

Pediatric

 

1A

    The patient meets at least one of the following:

1A

    1) Mechanical ventilation

1A

    2) Mechanical assist device, e.g., ECMO

1A

    3) Intra-aortic balloon pump

1A

    4) < Six months old with congenital or acquired heart disease with
         reactive pulmonary hypertension > 50 percent of systemic

1A

    5) Infusion of high dose or multiple inotropes

1A

    6) None of the above, but a life expectancy of < fourteen days
         without a heart transplant

1B

    Patient meets at least one of the following:

1B

    1) Infusion of low dose single inotrope

1B

    2) < Six months old and does not meet criteria for Status 1A

1B

    3) Growth failure, i.e., < 5th percentile for weight and/or height or
         loss of > 1.5 s.d. of expected growth (height or weight)

2

    Does not meet criteria for Status 1A or 1B

7

    Temporarily unsuitable to receive a thoracic organ transplant





There is significant variation among Donation Service Areas (DSAs) in time to transplant across the country. This map shows deceased donor heart donation rates (per 1000 deaths), by state, 2011-2013.



Percentage of adult wait-listed patients, 2013, who received a deceased donor heart transplant within one year, by DSA.


Source: American Journal of Transplantation
Volume 16, Issue S2, pages 115-140, 11 JAN 2016 DOI: 10.1111/ajt.13670




Adult heart recipients on circulatory support before transplant.


Source: SRTR 2014 Report




The characteristics of heart transplant recipients on the waiting list in years 2004 and 2014 are shown in the graph below. Two areas with significant changes are the wait list urgency status which shifted from Status 2 to 1A and 1B and the usage of VADs has increased almost 7 fold.




In addition to clinical status, wait times vary depending on the part of the country, blood type, body size and other recipient and donor variables.  Check the SRTR website for specific information on the center(s) you are considering.