Impact of the 2018 UNOS Heart Transplant Policy Changes on Patient Outcomes

JACC Heart Fail. 2023 May;11(5):491-503. doi: 10.1016/j.jchf.2023.01.009. Epub 2023 Mar 1.


In 2018, the United Network for Organ Sharing implemented a 6-tier allocation policy to replace the prior 3-tier system. Given increasing listings of critically ill candidates for heart transplantation and lengthening waitlist times, the new policy aimed to better stratify candidates by waitlist mortality, shorten waiting times for high priority candidates, add objective criteria for common cardiac conditions, and further broaden sharing of donor hearts. There have been significant shifts in cardiac transplantation practices and patient outcomes following the implementation of the new policy, including changes in listing practices, waitlist time and mortality, transplant donor characteristics, post-transplantation outcomes, and mechanical circulatory support use. This review aims to highlight emerging trends in United States heart transplantation practice and outcomes following the implementation of the 2018 United Network for Organ Sharing heart allocation policy and to address areas for future modification.

Keywords: 2018 allocation policy; United Network for Organ Sharing; heart transplant; outcome.

Publication types

  • Review

MeSH terms

  • Heart Failure* / surgery
  • Heart Transplantation*
  • Humans
  • Policy
  • Retrospective Studies
  • Tissue Donors
  • Tissue and Organ Procurement*
  • United States
  • Waiting Lists