{"id":8712,"date":"2025-09-20T19:47:06","date_gmt":"2025-09-20T16:47:06","guid":{"rendered":"https:\/\/jordan-cardiac.org\/?p=8712"},"modified":"2025-09-20T19:47:06","modified_gmt":"2025-09-20T16:47:06","slug":"impact-of-the-2018-u-s-heart-transplant-listing-priority-policy-on-survival","status":"publish","type":"post","link":"https:\/\/jordan-cardiac.org\/en\/impact-of-the-2018-u-s-heart-transplant-listing-priority-policy-on-survival\/","title":{"rendered":"Impact of the 2018 U.S. Heart Transplant Listing Priority Policy on Survival"},"content":{"rendered":"
Impact of the 2018 U.S. Heart Transplant Listing Priority Policy on Survival<\/div>\n
<\/div>\n
Source: AHA.\u00a0 Based on JACC: Heart Failure \u2013 July 2025<\/div>\n
<\/div>\n
Background<\/div>\n
In 2018, the United States restructured its heart transplant system to improve fairness and prioritize the sickest patients.<\/div>\n
\u2022 Old system (before 2018): 3 tiers or categories \u2014<\/span><\/div>\n
\u2022 Status 1A: very urgent (often with aggressive support).<\/span><\/div>\n
\u2022 Status 1B: intermediate.<\/span><\/div>\n
\u2022 Status 2: all other active candidates.<\/span><\/div>\n
\u2022 In the old U.S. system (before 2018), Status 1A was meant only for the very sickest patients.<\/span><\/div>\n
\u2022 But transplant centers realized that if they gave patients high-dose medicines (inotropes) or placed temporary support devices (like balloon pumps), those patients could automatically qualify for 1A.<\/span><\/div>\n
\u2022 As a result, too many patients were listed as 1A, even if some were not truly the sickest.<\/span><\/div>\n
\u2022 This made Status 1A overcrowded and less useful for distinguishing who really needed the heart most urgently.<\/span><\/div>\n
<\/div>\n
\u2022 New system (after 2018): Expanded to 6 statuses (1\u20136) for finer separation:<\/span><\/div>\n
\u2022 Status 1: sickest (e.g., ECMO, ventilator).<\/span><\/div>\n
\u2022 Status 2\u20133: very urgent (balloon pump, high-dose inotropes).<\/span><\/div>\n
\u2022 Status 4\u20136: less urgent, stable patients.<\/span><\/div>\n
\u2022 Goal: ensure donor hearts go first to those at highest true risk.<\/span><\/div>\n
<\/div>\n
Study Design<\/div>\n
\u2022 Observational analysis of 23,043 adult candidates using the SRTR database.<\/span><\/div>\n
\u2022 Pre-policy cohort: Oct 2013\u2013Oct 2016 (11,022 patients).<\/span><\/div>\n
\u2022 Post-policy cohort: Oct 2018\u2013Oct 2021 (12,021 patients).<\/span><\/div>\n
\u2022 Main outcome: 3-year survival benefit = extra days alive with transplant vs. waitlist.<\/span><\/div>\n
<\/div>\n
Results<\/div>\n
1. More transplants, faster:<\/span><\/div>\n
\u2022 65% \u2192 74% of patients received a transplant.<\/span><\/div>\n
\u2022 Average waiting time fell from 220 \u2192 129 days.<\/span><\/div>\n
2. Survival benefit doubled for the sickest:<\/span><\/div>\n
\u2022 Old Status 1A = 328 days \u2192 New Status 1 = 699 days gained.<\/span><\/div>\n
3. Overall improvement:<\/span><\/div>\n
\u2022 Average benefit per transplant: 217 \u2192 241 days.<\/span><\/div>\n
\u2022 First 3 years: 1,645 extra life-years saved nationwide.<\/span><\/div>\n
<\/div>\n
Conclusion<\/div>\n
The 2018 U.S. Listing Priority Policy achieved its main goal: better sorting of patients by urgency, reduced waiting time, and significant increases in survival benefit \u2014 especially for the sickest candidates.<\/div>\n
<\/div>\n
Relevance for JCS:<\/div>\n
This experience shows how refining transplant listing criteria can maximize the impact of scarce donor organs. Developing region-specific policies in Jordan and the Middle East could similarly ensure that hearts reach the most urgent patients first, saving more lives and aligning national practice with global best standards.<\/div>\n
<\/div>\n
https:\/\/click.mail.medscape.com\/?qs=c9cb83c52070cc988c638ff83ba56630fb11abf1435163e992dd7647f80c892f0b7602bb4015191aaf4a1659c97679b941135ceb29b66fd6f31e8999779e008e<\/a><\/div>\n
<\/div>\n","protected":false},"excerpt":{"rendered":"

Impact of the 2018 U.S. Heart Transplant Listing Priority Policy on Survival Source: AHA.\u00a0 Based on JACC: Heart Failure \u2013 July 2025 Background In 2018, the United States restructured its heart transplant system to improve fairness and prioritize the sickest patients. \u2022 Old system (before 2018): 3 tiers or categories \u2014 \u2022 Status 1A: very […]<\/p>\n","protected":false},"author":145,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-8712","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/8712","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/users\/145"}],"replies":[{"embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/comments?post=8712"}],"version-history":[{"count":1,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/8712\/revisions"}],"predecessor-version":[{"id":8713,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/8712\/revisions\/8713"}],"wp:attachment":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/media?parent=8712"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/categories?post=8712"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/tags?post=8712"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}