The New UNOS Heart Allocation Changes Significantly Changed the Landscape of Heart Transplantation

Under the new allocation we have seen a significant rise in the ECMO and IABP utilization resulting in an increase in the proportion of status 1, 2 and 3 compared to status 1A group but was associated with a significant reduction in the status 4 patients (former status 1B). While this new allocation prioritizes a reduction in wait times and mortality, we have observed that this is associated with higher transplant mortality in status 1, 2, 3 and 4 patients. Finally, more time and data is required to determine if the new allocation results in reduced wait list mortality at the cost of lower post-transplant survival.