Table 3.
The comparison of highest priority groups between the contemporary allocation systems in the USA, Spain, France and the United Kingdom.
| USA a [21] | Spain b [31] | France c* [32] | United Kingdom d [33] |
|---|---|---|---|
| HT candidates on ECMO (maximum time of stay for these patients in the highest urgency grade is <7 days with possible prolongation for additional 7 days.) HT candidates with non-dischargeable surgically implanted VAD HT candidates with MCS device and with life-threatening ventricular arrhythmia |
HT candidates dependent on temporary MCS and cannot be weaned off the device HT candidates with durable VADs and with complications (infection, pump failure, or thrombosis) The patients with ECMO or any temporary MCS offering partial support must be on the MCS a minimum of 48 h before entering the highest urgency status list and only provided they do not present criteria of multi-organ failure. The maximum time of stay for these patients in the highest urgency grade is <7 days. |
HT candidate with the highest national score. The allocation system is based on a national score, going from 0 to 1151 and ranking all candidates. The candidate risk score (CRS) is the cornerstone of the allocation score. CRS includes VA ECMO use, plasma concentrations of natriuretic peptides, glomerular filtration rate (GFR) and total serum bilirubin level; CRS is generated by summing the products of each predictor multiplied by its coefficient Exceptions: Nine hundred points are allocated immediately or over a three-month period to patients on durable VAD with device-related complications and to patients on uncomplicated BiVAD and total artificial heart, as well as to those with sustained ventricular arrhythmia and to those with contraindications to durable VAD Time allowed for ECMO patients bridged to HT to stay in the highest priority group <12–16 days |
HT candidate on temporary VAD or VA-ECMO support. HT candidate (a) on intra-aortic balloon pump (IABP) support (b) at imminent risk of death or irreversible complications. Meets criteria for urgent listing but is not suitable for long-term VAD |
a highest priority category—‘Status 1’; b highest priority category—‘Urgency status 0’; c highest priority category—highest national score; d highest priority category—‘Super-Urgent Heart Allocation Scheme’; * In the period 2004–2016 highest urgency status in France was reserved for HT candidates on ECMO support or those on intravenous inotrope infusion [32].