See Article by Parker et al

The national heart allograft allocation algorithm established by the Organ Procurement and Transplantation Network has undergone several major changes over the years. The main goals of these policy modifications have been to respond to the evolving treatment options for advanced heart failure patients, minimize the risk of death on the waiting list, and maximize the benefit of transplant.¹ An aspirational goal has also been to achieve as much uniformity as possible in the practical application of the allocation algorithm.

Every modification of the allocation policy in the past has been met with a good dose of anxiety in anticipation of what the implemented change will mean. Will the benefits to transplant candidates predicted by the statistical modeling of waiting list events be realized? Will the change affect the required level of staffing or the established process logistics of organizations participating in donation, procurement, and transplantation? Will the change alter transplant volumes at one’s transplant center? Yet, the more contentious aspect has typically been the issue of uniform application of the policy from one transplant program to another and from patient to patient—a subject matter that can be best characterized as fairness.

In this issue of Circulation: Heart Failure, Parker et al² present their evaluation of one aspect of the fairness of the current heart allocation in the United States. They hypothesized that changes have taken place over time in the listing practices under the current Organ Procurement and Transplantation Network allocation …

见帕克等人的文章

多年来，由器官采购和移植网络建立的国家心脏同种异体移植分配算法已经发生了几项重大变化。这些政策修改的主要目标是对晚期心力衰竭患者不断发展的治疗选择做出反应，将等待名单上的死亡风险降到最低，并使移植受益最大化。¹理想的目标还在于在分配算法的实际应用中获得尽可能高的一致性。

过去对分配策略的每次修改都因预期实施的变更意味着什么而感到焦虑。通过等待名单事件的统计模型预测的移植候选人的好处是否会实现？变更是否会影响所需的人员配备水平或参与捐赠，采购和移植的组织的既定流程后勤？变化会改变一个人的移植中心的移植量吗？然而，更具争议性的方面通常是从一个移植程序到另一个移植程序以及从一个病人到另一个病人，统一应用该政策的问题，这一主题最能体现为公平。

在本期《循环：心力衰竭》中，Parker等人²提出了他们对美国当前心脏分配公平性的一个方面的评估。他们假设在当前的器官采购和移植网络分配下，上市做法随时间发生了变化……