Does the new heart transplant allocation policy encourage gaming by
providers?

Date:
October 20, 2020
Source:
Michigan Medicine - University of Michigan
Summary:
A new national policy was created to make determining who receives
a heart transplant more fair. But new data shows it changed some
practice patterns, too.



FULL STORY ==========================================================================
For the past two years, a different national allocation policy has been
in effect in order to more fairly distribute hearts to those who require
a life- saving transplant. People who need temporary mechanical pumps to support their hearts, like ECMO (extracorporeal membrane oxygenation)
or a temporary LVAD (left ventricular assist device), are now given
high preference.


========================================================================== These mechanical pumps are meant to be markers of illness severity,
and thus, identify the sickest patients who would benefit most from a
heart transplant.

However, a new research letter published by scientists at the Michigan
Medicine Frankel Cardiovascular Center finds clinicians gave more
patients these mechanical pumps once the new policy was in place than
they had previously.

That in turn moves more patients up the list for a transplant.

"Following the policy change, use of certain types of mechanical pumps increased up to five times," says lead author Jessica Golbus, M.D., an
advanced heart failure and heart transplant cardiology fellow at the
Frankel CVC. "There was notably greater use of these pumps among men
following the policy change, potentially giving them priority on the
heart transplant list. This may reflect gaming of the system and has
the potential to worsen outcomes such as gender disparities in heart transplantation." Co-author Monica Colvin, M.D., a heart failure and transplant cardiologist at the Frankel CVC, says transplant allocation
policy changes are frequently accompanied by changes in listing practices
in an effort to optimize listing strategies for individual patients.

"It remains to be seen whether this is a better strategy for transplant patients or whether this will create the same problems faced by the prior policy," says Colvin, also a professor of internal medicine. "These
types of analyses are essential in helping the community understand
the challenges of policy development and its effect on patients and
transplant centers, and will help to inform future policy."

========================================================================== Story Source: Materials provided by
Michigan_Medicine_-_University_of_Michigan. Original written by Haley
Otman. Note: Content may be edited for style and length.


========================================================================== Journal Reference:
1. Jessica R. Golbus, Kashvi Gupta, Monica Colvin, Thomas M. Cascino,
Keith
D. Aaronson, Dharam J. Kumbhani, Rajiv Saran, Brahmajee
K. Nallamothu.

Changes in Type of Temporary Mechanical Support Device Use Under
the New Heart Allocation Policy. Circulation, 2020; 142 (16):
1602 DOI: 10.1161/ CIRCULATIONAHA.120.048844 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2020/10/201020131345.htm

--- up 8 weeks, 1 day, 6 hours, 50 minutes
* Origin: -=> Castle Rock BBS <=- Now Husky HPT Powered! (1337:3/111)