Summary
OPTN/UNOS' efforts over the past three decades to reduce waiting list mortality and improve posttransplant survival have been successful. However, with steady growth in the number of heart transplant candidates, the OPTN/UNOS Board mandated the Thoracic Committee to evaluate opportunities for broader, more equitable organ sharing of donor hearts. The Thoracic Committee has begun work on a new heart allocation system that expands the number of allocation statuses, accounts for severity of illness, considers geographic variations in heart allocation, incorporates the emerging population of VAD patients, with and without associated complications, includes previously disenfranchised groups of patients, and focuses on candidates' underlying physiology rather than their diagnoses. These modifications will lead to the development of a more effective and equitable heart allocation system.