Table 4 History and development of Heart allocation (Heart Tier System)
Name | Contributing Author(s) | Year of Publication | Year of Adoption by UNOS | Objective | Categories | Changes to Categories |
|---|---|---|---|---|---|---|
Heart Tier System (2 tiers) | N/A | N/A | 1988 | Stratify recipient risks based on clinical treatment | Used for both adults and children. Status 1: 1) Individuals with an implanted mechanical circulatory support (MCS) device including an intra-aortic balloon pump (IABP), total artificial heart (TAH), ventricular assist device (VAD) 2) Individuals who are continuously intubated 3) Individuals admitted to the intensive care unit for inotropic support. 4) Individuals younger than 6 months. Status 2: All other patients eligible for transplant. | N/A |
Heart Tier System (3 tiers) | N/A | N/A | 2005 | Stratify recipient risks based on clinical treatment | Status 1 A: 1) Individuals with an implanted mechanical circulatory support (MCS) device including an intra-aortic balloon pump (IABP), total artificial heart (TAH), and extracorporeal membrane oxygenation (ECMO) 2) Individuals on continuous inotropic support and hemodynamic monitoring 3) Individuals with dischargeable VADs (> 30 days) or VAD complications 4) Individuals on continuous mechanical ventilation Status 1B: 1) All other individuals who are stable on LVAD/RVAD 2) Individuals on continuous IV inotropic support without hemodynamic monitoring Status 2: All other patients eligible for transplant. | Increased in priority: ↑ N/A Decreased in priority: ↓ All other individuals who are stable on LVAD/RVAD ↓ Individuals on continuous IV inotropic support without hemodynamic monitoring |
Heart Tier System (6 tiers) |  | 2018 | 2018 | Stratify recipient risks based on clinical treatment | Status 1: 1) ECMO for up to 7 days 2) Implanted, non-dischargeable BiVAD 3) MCS device with life threatening ventricular arrythmias Status 2: 1) Dischargeable BiVAD/RVAD 2) Non-dischargeable LVAD, IABP, or percutaneous MCS for up to 14 days 3) MCS device failure 4) Total artificial heart Status 3: 1) Dischargeable LVAD for up to 30 days 2) Individuals on continuous inotropic support and hemodynamic monitoring 3) ECMO after 7 days 4) Non-dischargeable LVAD, IABP, or percutaneous MCS devices after 14 days 5) MCS devices with complications Status 4: 1) Stable on LVAD 2) Individuals on continuous IV inotropic support without hemodynamic monitoring 3) Congenital Heart Disease 4) Re-transplant 5) Restrictive cardiomyopathy 6) Amyloidosis 7) Hypertrophic myopathy 8) Ischemic heart disease with recurrent angina Status 5: 1) Multiorgan transplant Status 6: All other patients eligible for transplant. | Increased in priority: ↑ N/A Decreased in priority: ↓ Stable on LVAD ↓ Individuals on continuous IV inotropic support without hemodynamic monitoring |