The Future Direction of the Adult Heart Allocation System in the United States
The Future Direction of the Adult Heart Allocation System in the United States
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DOI：
10.1111/ajt.13030
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发表时间：
2015-01-01
影响因子：
8.8
通讯作者：
Cleveland, J. C., Jr.
中科院分区：
文献类型：
--
作者：
Meyer, D. M.;Rogers, J. G.;Cleveland, J. C., Jr.
确保公平和公正的器官分配是器官共享联合网络（UNOS）的核心职责，通过与卫生和人类服务部（DHHS）的合同，作为器官采购和移植网络（OPTN）。巴勒斯坦被占领土/联合国业务联络处理事会开始重新评估目前的分配制度。本文描述了OPTN/UNOS心脏小组委员会代表OPTN/UNOS胸器官移植委员会修改当前分配系统的努力。小组委员会评估了当前三层系统的局限性、状态异常患者的结局、新出现的心室辅助装置（VAD）人群、改善地理共享的选择以及潜在被剥夺权利群体的状态。他们分析了当代高危患者群体的等待名单和移植后死亡率，并与移植受体科学登记处合作，制定了一项拟议的多层分配计划。这项建议提供了一个模拟建模的框架，以预测候选人是否会有更好的等待名单生存在修订后的分配系统，以及移植后生存是否会保持稳定。根据心脏小组委员会的进一步分析，这些等级可能会发生变化，并将导致一个更有效和公平的心脏分配系统的发展。器官共享联合网络胸科委员会提出了一个修订后的多层心脏分配计划，旨在改善主要基于当代等待名单死亡风险的优先分层。另见巴尔和泰勒的社论（第页）和小林川等人的会议报告（第页）。
Ensuring equitable and fair organ allocation is a central charge of the United Network for Organ Sharing (UNOS) as the Organ Procurement and Transplantation Network (OPTN) through its contract with the Department of Health and Human Services (DHHS). The OPTN/UNOS Board initiated a reassessment of the current allocation system. This paper describes the efforts of the OPTN/UNOS Heart Subcommittee, acting on behalf of the OPTN/UNOS Thoracic Organ Transplantation Committee, to modify the current allocation system. The Subcommittee assessed the limitations of the current three-tiered system, outcomes of patients with status exceptions, emerging ventricular assist device (VAD) population, options for improved geographic sharing and status of potentially disenfranchised groups. They analyzed waiting list and posttransplant mortality rates of a contemporary cohort of patient groups at risk, in collaboration with the Scientific Registry of Transplant Recipients to develop a proposed multi-tiered allocation scheme. This proposal provides a framework for simulation modeling to project whether candidates would have better waitlist survival in the revised allocation system, and whether posttransplant survival would remain stable. The tiers are subject to change, based on further analysis by the Heart Subcommittee and will lead to the development of a more effective and equitable heart allocation system.The Thoracic Committee of the United Network for Organ Sharing is proposing a revised, multi-tier heart allocation scheme in the United States that is designed to improve priority stratification based primarily upon contemporary waitlist mortality risk. Also see editorial by Barr and Taylor (page ) and meeting report by Kobashigawa et al (page ).