TABLE 1.

Continuous Distribution for Organ Allocation: Challenges and Proposed Solutions

Continuous Distribution Score Component	Challenge	Proposed Solutions
Medical urgency	Unclear how to convert 6 therapy-based categories into continuous score	Develop novel multivariable model using post-2018 data and ensure that it is less susceptible to manipulation
Post-transplantation survival	Difficult to predict post-transplantation outcomes using only candidate waitlist data	Update post-transplantation models and use donor-candidate interactions. Assign a small weight to this score component
Patient access	Candidates with durable LVADs will have substantially lower medical urgency score	Add points for waiting time for patients with durable LVAD and those ineligible for LVAD therapy
Candidate biology	Patients with blood type O and who are highly sensitized are at a disadvantage	Add points for candidates with blood type O and who are highly sensitized
Placement efficiency	Evolving organ transport and preservation technologies make ischemic time effects difficult to estimate	Assign a very small weight to this score component

LVAD = left ventricular assist device.