
Variation in practice patterns and outcomes across United Network for Organ Sharing allocation regions
Author(s) -
Srinivasan Dushyanth,
Vaccaro Benjamin,
Rao Pooja,
Ghosh Rohit,
Warier Prashant,
Ahmad Tariq,
Desai Nihar
Publication year - 2018
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.22854
Subject(s) - medicine , united network for organ sharing , transplantation , heart transplantation , inotrope , organ transplantation , emergency medicine , liver transplantation
Background The number of heart transplants performed is limited by organ availability and is managed by the United Network for Organ Sharing (UNOS). Efforts are underway to make organ disbursement more equitable as demand increases. Hypothesis Significant variation exists in contemporary patterns of care, wait times, and outcomes among patients undergoing heart transplantation across UNOS regions. Methods We identified adult patients undergoing first, single‐organ heart transplantation between January 2006 and December 2014 in the UNOS dataset and compared sociodemographic and clinical profiles, wait times, use of mechanical circulatory support (MCS), status at time of transplantation, and 1‐year survival across UNOS regions. Results We analyzed 17 096 patients undergoing heart transplantation. There were no differences in age, sex, renal function, and peripheral vascular resistance across regions; however, there was 3‐fold variation in median wait time (range, 48–166 days) across UNOS regions. Proportion of patients undergoing transplantation with status 1A ranged from 36% to 79% across regions ( P < 0.01), and percentage of patients hospitalized at time of transplantation varied from 41% to 98%. There was also marked variation in MCS and inotrope utilization (28%–57% and 25%–58%, respectively; P < 0.001). Durable ventricular assist device implantation varied from 20% to 44% ( P < 0.001), and intra‐aortic balloon pump utilization ranged from 4% to 18%. Conclusions Marked differences exist in patterns of care across UNOS regions that generally trend with differences in waitlist time. Novel policy initiatives are required to address disparities in access to allografts and ensure equitable and efficient allocation of organs.