The introduction of a super-urgent heart allocation scheme in the UK: a two-year review

ABSTRACT Background In response to a growing number of patients on the UK urgent heart transplant waiting list, the UK donor heart allocation scheme was revised in October 2016 with the introduction of a new super-urgent category. Patients with temporary mechanical circulatory support (tMCS) became eligible for super-urgent registration. The aim of this study was to compare activity, indications, and outcomes before and after the change. Methods Data on adult (age>=16) heart transplant registrations and recipients in the two years before (era 1: July 2014-30 June 2016) and after (era 2: January 2017- December 2018) the introduction of the new scheme were extracted from the UK Transplant Registry and analysed using competing risks analysis, Kaplan-Meier analysis and Cox proportional hazards regression. Results There were 525 waiting list registrations in era 1 and 594 in era 2 , including 14% super-urgent registrations, with 90% having some form of tMCS. Median waiting time to transplant was 41 days for all urgent registrations in era 1 compared with 17 days for super-urgent registrations and 71 days for urgent registrations in era 2. Numbers of non-urgent transplants were not affected. Deaths on the waiting list significantly decreased from 5% to 2% at 6 months between era 1 and 2 (adjusted HR=0.29, 95% CI: 0.13-0.62). In addition, total numbers of tMCS patients were not different between both eras, suggesting no significant change in this area of clinical decision making. Post-transplant survival at 1 year for super-urgent recipients was not significantly different from other categories. Conclusions Introduction of a super-urgent heart allocation scheme in the UK reduces waiting time to transplant for the sickest patients with comparable post-transplant survival while reducing deaths on the waiting list.