Heart-Kidney Allocation Policy and Proposals Impact Equity of Access for Patients with End-Stage Kidney Disease

Purpose of Review To summarize contemporary evidence describing the most appropriate candidates for simultaneous heart kidney transplantation (SHK), estimates of how SHK affects the entire transplantation system and implications of recently enacted SHK allocation policy on kidney transplantation. Recent Findings SHK has benefits for both dialysis-dependent patients and non-dialysis-dependent patients with eGFRs up to approximately 40 mL/min/1.73 m 2 . Additionally, there is emerging data that patients with left ventricular assist devices may be inferior candidates for SHK. Recent modelling has also shown that multiorgan transplant generally diverts kidneys away from patients waiting for kidney transplant alone, who suffer inferior wait list outcomes relative to individuals who receive kidney offers from a heart, liver, or lung donor. Summary SHK is an important part of the transplant system, but increased scrutiny is warranted. Further investigations into optimal candidate selection, preoperative and perioperative reno-protective strategies, and the effects of new SHK policies on the kidney alone waitlisted population are needed.