Nationally, there are over 4,350 patients waiting for a heart or heart-lung transplant.

Policy 3.7 Organ Distribution

3.7 Allocation of Thoracic Organs. This policy describes how thoracic organs (hearts, heart-lung combinations, single and double lungs) are to be allocated to patients awaiting a thoracic organ transplant.

3.7.1 Exceptions. Unless otherwise approved according to Policies 3.1.7 (Local and Alternative Local Unit), 3.1.8 (Sharing Arrangement and Sharing Agreement), 3.1.9 (Alternate Point Assignments (Variances)), and 3.4.6 (Application, Review, Dissolution and Modification Processes for Alternative Organ Distribution or Allocation Systems), or specifically allowed by the exceptions described in this Policy 3.7.1, all thoracic organs must be allocated in accordance with Policy 3.7.

3.7.1.1 Exception for Sensitized Patients. The transplant surgeon or physician for a patient awaiting thoracic organ transplantation may determine that the patient is "sensitized" such that the patient's antibodies would react adversely to certain donor cell antigens. It is permissible not to use the allocation policies set forth in Policy 3.7 for allocation of a particular thoracic organ when all thoracic organ transplant centers within an OPO and the OPO agree to allocate the thoracic organ to a sensitized patient because results of a crossmatch between the blood serum of that patient and cells of the thoracic organ donor are negative (i.e., the patient and thoracic organ donor are compatible). The level of sensitization at which a patient may qualify for this exception is left to the discretion of the listing transplant center, and subject to agreement among all thoracic organ transplant centers within an OPO and the OPO. Sensitization is not a qualifying criterion for assigning a patient to a heart status category as described in UNOS Policies 3.7.3 (Adult Patient Status) and 3.7.4 (Pediatric Patient Status).

3.7.2 Geographic Sequence of Thoracic Organ Allocation. Thoracic organs are to be allocated locally first, then within the following zones in the sequence described in Policy 3.7.10. Three zones will be delineated by concentric circles of 500 and 1,000 nautical mile radii with the donor hospital at the center. Zone A will extend to all transplant centers which are within 500 miles from the donor hospital but which are not in the local area of the donor hospital. Zone B will extend to all transplant centers that are at least 500 miles from the donor hospital but not more than 1,000 miles from the donor hospital. Zone C will extend to all transplant centers that are located beyond 1,000 miles from the donor hospital.

3.7.3 Adult Patient Status. Each patient awaiting heart transplantation is assigned a status code which corresponds to how medically urgent it is that the patient receive a transplant. Medical urgency is assigned to a heart transplant patient who is greater than or equal to 18 years of age at the time of listing as follows:

Status Definition 1A A patient listed as Status 1A is admitted to the listing transplant center hospital and has at least one of the following devices or therapies in place: (a) Mechanical circulatory support for acute hemodynamic decompensation that includes at least one of the following: (i) left and/or right ventricular assist device implanted for 30 days or less; (ii) total artificial heart; (iii) intra-aortic balloon pump; or (iv) extracorporeal membrane oxygenator (ECMO). Qualification for Status 1A under this criterion is valid for 14 days and must be recertified by an attending physician every 14 days from the date of the patient's initial listing as Status 1A to extend the Status 1A listing. (b) Mechanical circulatory support for more than 30 days with objective medical evidence of significant device-related complications such as thromboembolism, device infection, mechanical failure and/or life-threatening ventricular arrhythmias (Patient sensitization is not an appropriate device-related complication for qualification as Status 1A under this criterion. The applicability of sensitization to thoracic organ allocation is specified by UNOS Policy 3.7.1.1 (Exception for Sensitized Patients)). Qualification for Status 1A under this criterion is valid for 14 days and must be recertified by an attending physician every 14 days from the date of the patient's initial listing as Status 1A to extend the Status 1A listing. (c) Mechanical ventilation. Qualification for Status 1A under this criterion is valid for 14 days and must be recertified by an attending physician every 14 days from the date of the patient's initial listing as Status 1A to extend the Status 1A listing. (d) Continuous infusion of a single high-dose intravenous inotrope (e.g., dobutamine >/= 7.5 mcg/kg/min, or milrinone >/= .50 mcg/kg/min), or multiple intravenous inotropes, in addition to continuous hemodynamic monitoring of left ventricular filling pressures; Qualification for Status 1A under this criterion is valid for 7 days and may be renewed for an additional 7 days for each occurrence of a Status 1A listing under this criterion for the same patient. (e) A patient who does not meet the criteria specified in (a), (b), (c) or (d) may be listed as Status 1A if the patient is admitted to the listing transplant center hospital and has a life expectancy without a heart transplant of less than 7 days. Qualification for Status 1A under this criterion is valid for 7 days and may be recertified by an attending physician for one additional 7-day period. Any further extension of the Status 1A listing under this criterion requires a conference with the applicable UNOS Regional Review Board.