Abstract 16061: Effects of UNOS Policy Changes on Market Competition and Heart Transplant Outcomes
Introduction: Higher competition among transplant centers is associated with improved access of higher-risk patients to extrathoracic organ transplantation but worse outcomes. The effects of major United Network for Organ Sharing (UNOS) policies on competition for hearts are unknown. We studied associations of listing priority (1999) and organ allocation policy revisions (2006) with local organ procurement organization (OPO) competition and heart transplant (HT) outcomes.
Methods: In the UNOS database we found 80 OPOs providing hearts to 45,727 adults from 1988-2013. We calculated for each OPO yearly a Herfindahl-Herschmann Index (HHI) that varies inversely with competition and used segmented regression analysis to assess trends.
Results: Aggregate local competition was stable in era 1 (1988-2000) then increased until 2006 (era 2), after which there was an increase in competition but subsequent reversal of the previous trend (era 3; Figure). Across all eras, increasing competition was associated with higher proportions of recipients who were nonwhite, status 1 or 1A, and received IABP or LVAD bridging (all p <0.0001 for era, competition and era*competition). Despite a progressive increase in center volume with level of competition (p <0.0001), patients served by higher-competition OPOs in era 3 had higher post-HT death and graft failure rates (p <0.0001).
Conclusions: Policy revisions regarding listing criteria and organ allocation have been associated with specific changes in local competition. The most competitive OPOs appear to serve sicker patients but have lower post-HT survival. Understanding effects of market competition may inform future policy decisions.
Author Disclosures: R.C. Givens: None. J. Lewey: None. D.M. Mancini: None. P.C. Schulze: None.
- © 2015 by American Heart Association, Inc.