FIGURE 1. Visual Summary of the New OPTN/UNOS Shock Criteria for Adult Heart Transplant Candidates.

Under the new adult heart allocation system, candidates listed with veno-arterial extracorporeal membrane oxygenation, percutaneous ventricular assist devices, intra-aortic balloon pump, and high-dose inotropes will be subject to cardiogenic shock criteria (based on American Heart Association definitions) to qualify for high-priority listing. The criteria include either meeting hemodynamic requirements and minimum inotrope doses (left) or having evidence of poor end-organ perfusion (right). *Candidates supported with surgically placed mechanical circulatory support devices (such as continuous-flow left ventricular assist devices) are exempt from the requirement. †Candidates supported with high-dose inotropes are allowed to have a cardiac index up to 2.2 l/min/m² while in support. ALT = alanine transaminase; AST = aspartate transaminase; CPR = cardiopulmonary resuscitation; N/A = not available; OPTN = Organ Procurement and Transplant Network; SBP = systolic blood pressure; UNOS = United Network for Organ Sharing.