Use of Temporary Mechanical Circulatory Support for Management of Cardiogenic Shock Before and After the United Network for Organ Sharing Donor Heart Allocation System Changes

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Abstract
In October 2018, the United Network for Organ Sharing (UNOS) changed its donor heart allocation system in an effort to reduce mortality among patients on a waiting list.1 Patients treated with temporary, nondischargeable mechanical circulatory support (MCS) had the highest waitlist mortality and thus received the highest priority under the new system. Specifically, UNOS status 1 now includes patients supported with venoarterial extracorporeal membrane oxygenation (VA-ECMO) or surgically implanted, nondischargeable MCS devices, and UNOS status 2 includes support with intra-aortic balloon pump (IABP) or percutaneous MCS devices (eg, microaxial intracardiac ventricular assist device). Patients supported only with inotropes are assigned a lower status (eTable 1 in the Supplement).

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