Korean J Transplant.  2022 Nov;36(Supple 1):S115. 10.4285/ATW2022.F-2333.

Expert recommendations for new heart allocation system in Korea

• Lee H
• Cho HJ
• Yoon YN
• Choi JO
• Youn JC
• Kim IC
• Hyun J
• Cho YH

• KMID: 2535631
• DOI: http://doi.org/10.4285/ATW2022.F-2333

Abstract

Background
Despite the introduction of the new Korean heart allocation system in 2018, donor heart utilization has been still suboptimal. Waitlist mortality has worsened due to an increase in transplantation under extracorporeal membrane oxygenation (ECMO) support. Posttransplantation survival has not improved significantly. Accordingly, requirements for revision of the allo-cation system have been emerging. This study aimed to propose expert recommendations for a new heart allocation system in Korea.
Methods
The recommendation for revision of the allocation system was established based on analyses of heart transplantation data from the Korean Network for Organ Sharing (KONOS) and Korean Organ Transplantation Registry (KOTRY) data and the questionnaires from heart transplantation experts in Korea.
Results
The questionnaires were obtained from 69/129 (53.5) experts. 82.6% answered revision of the allocation system is needed. The main revisions for the new heart allocation system include (1) requirements for detailed patient clinical assessment data at the time of recipient registration. (2) Requirement of exceptional approval for age >75 for status 0. (3) Reassessments of reasons for maintaining ECMO or ventilator support every 2 weeks. (4) Detail of serious complications after left ventricular assist (LVAD) was redefined.
Conclusions
It is still concerned about high waitlist mortality and stagnation of posttransplantation survival in the current heart allocation system. The recommendations may provide guidance to overcome problems of the current heart allocation system.