Clinical transplantation | 2021
Geographic Disparities in Heart Transplantation Persist under the New Allocation Policy.
Abstract
BACKGROUND\nThis study evaluated the impact of the 2018 heart allocation policy change on geographic disparities in United States orthotopic heart transplantation (OHT).\n\n\nMETHODS\nThe United Network for Organ Sharing registry was queried to measure geographic disparity in OHT rates between pre-policy and post-policy change eras. We performed multilevel Poisson regression to measure region-level OHT rates. We derived an allocation priority-adjusted median incidence rate ratio (MIRR) for each policy era, a measure of median change in OHT rates between regions.\n\n\nRESULTS\n5,958.78 waitlist person-years were analyzed, comprising 6,596 OHT procedures (3,890 pre-policy and 2,706 post-policy). Median region-level OHT rate was 0.94 transplants/person-years before and 1.51 transplants/person-years after the policy change (p<0.001). The unadjusted OHT MIRR across regions was 1.29 (95% CI 1.00-1.50) pre-policy change and 1.17 (95% CI 1.00-1.43) post-policy change, suggesting that the region-related variance in OHT rates decreased under the new allocation. After adjustment for allocation priority risk factors, the MIRR pre-policy change was 1.13 (95% CI 1.01-1.32) and post-policy change was 1.15 (95% CI 1.00-1.35).\n\n\nCONCLUSIONS\nGeography accounts for ∼10% of the disparity among United States OHT rates. Despite broader heart sharing, the updated allocation policy did not substantially alter the existing geographic disparities among OHT recipients. This article is protected by copyright. All rights reserved.