Table 2.

Eurotransplant Heart Allocation System Tiers

International High Urgency Status

● Inotrope dependency

○ Meeting following 3 criteria for cardiac hypoperfusion syndrome

■ Signs and symptoms of terminal heart failure

■ Hemodynamic features

● Cardiac index < 2.0 L/min/m2

● Mixed venous saturation < 50%

● Pulmonary capillary wedge pressure > 15 mm Hg

■ Secondary organ damage (at least one of the following)

● Lactate above normal

● Bilirubin above normal

● Calculated GFR < 60 ml/min

● Serum sodium < 135 mmol/L

○ Meeting one of the following 2 criteria for inotrope dependency

■ When on continuous inotrope infusion with Dobutamine, Milrinone, or Enoximone for at least 72 hours

● Cardiac index stays < 2.0 L/min/m2 OR

● There is proof of decrease in cardiac index below 2.0 L/min/m2 when inotrope is weaned

■ Cardiac hypoperfusion syndrome within 14 days of a single infusion of Levosimendan

● Complications while on assist device

○ Assist device complication requiring device exchange OR

○ Infection on assist device with positive cultures or other proof (driveline infection excluded) OR

○ Repeated assist device related cerebral events demonstrated by CT scan

● Additional Special Cases

○ Primary graft failure within 1 week after transplant

National High Urgency Status

● Granted according to national policies

Normal Urgency Status

● Stable assist device or total artificial heart patients

● Stable heart failure patients not meeting urgency status criteria