Impact of the Eurotransplant high-urgency heart allocation system on the outcome of transplant candidates in Germany

• Published in: The Thoracic and cardiovascular surgeon Vol. 59; no. 2; p. 93
• Main Authors: Haneya, A, Haake, N, Diez, C, Puehler, T, Cremer, J, Schmid, C, Hirt, S W
• Format: Journal Article
• Language: English
• Published: Germany 01.03.2011
• Subjects: Adult; Aged; Chi-Square Distribution; Cold Ischemia; Comorbidity; Female; Germany - epidemiology; Government Regulation; Health Care Rationing - legislation & jurisprudence; Heart Failure - diagnosis; Heart Failure - mortality; Heart Failure - surgery; Heart Transplantation - adverse effects; Heart Transplantation - legislation & jurisprudence; Heart Transplantation - mortality; Humans; Intensive Care Units; Kaplan-Meier Estimate; Length of Stay; Male; Middle Aged; Outcome and Process Assessment (Health Care); Program Evaluation; Reoperation; Retrospective Studies; Risk Assessment; Risk Factors; Severity of Illness Index; Survival Rate; Time Factors; Tissue and Organ Procurement - legislation & jurisprudence; Tissue Donors - legislation & jurisprudence; Tissue Donors - supply & distribution; Treatment Outcome; Waiting Lists; Germany
• ISSN: 1439-1902
• DOI: 10.1055/s-0030-1250482

In 2000, the Eurotransplant Foundation changed the allocation criteria following the enactment of the German Transplantation Law (GTL). Our study investigated the impact of the new allocation system on outcomes after heart transplantation (HTx) in Germany. We compared 2 cohorts of patients who underwent HTx at our institution in two different 3-year periods before (Group 1: 01/1995-12/1997) and after (Group 2: 01/2003-12/2005) implementation of the new system. An increase in the ratio of HTx performed on an urgency basis was found in Group 2 (8.3 % vs. 87.2 %; P < 0.001). The median waiting time and the ischemia time were significantly lower in Group 1 ( P < 0.05). Postoperatively, the length of ICU stay was significantly higher in Group 2 ( P = 0.04). The new allocation system decreased the proportion of local and regional organ harvesting. It generates a higher ischemia time without increasing the number of transplantations and without improving the clinical outcome after HTx. The severity of heart failure, rate of secondary organ impairment, and comorbidity is markedly elevated in patients waiting for HTx on HU.