Heart Failure to Transplant: Estimating Wait Time

The following was posted to my CaringBridge journal on Jan 16, 2015:

The transplant list is kept nationally, but it is not exactly first come first served.  Time on the list is only one of many factors that go into determining who receives the offer when an heart becomes available.

Say that someone experiences a traumatic injury and is declared brain dead, and has stated their preference to be an organ donor.

If this happens in Los Angeles, the transplant coordinator would first look for a matching recipient in the Organ Procurement Organization (OPO) sub-region that LA is part of (I believe it's Region 5).

The transplant coordinator would look in the database of transplant candidates within Region 5 to see who matches the donor in terms of size, blood type and other immune factors.  I think they also consider age of the donor compared to age of the recipient.  They wouldn't give me a 70 year old heart, for example.

If more than one candidate is a good match for the donor, then they look at how sick the candidates are.  This is where the priority statuses come in.  1As get priority, then 1Bs, then Status 2s.  

If there are no 1As and more than one 1B that is a good match for the donor, then it comes down to who has accrued the most time waiting.  I was placed on the list officially as of January 12, so my wait time starts accruing from that date.

If there are no matches for the donor at all in Region 5, then they would offer the organ to matching candidates in neighboring OPOs (there are two covering Northern California and one that covers San Diego).  The process would be repeated for neighboring regions in Oregon and Nevada and so on until a matching recipient is found.

My blood type is O, the most common type, which puts me in a large group of candidates.  But my petite size means I need a small heart.  

Cardiomyopathy like I have is a relatively rare reason for heart failure.  More common is coronary artery disease and heart attack.  Those on the list for those reasons likely tend to be older and bigger than me.  Those who experience traumatic injuries and brain death tend on the whole to be younger (because of more risk-taking behavior in the young) and potentially have hearts on the smaller end of the spectrum. 

So, there are fewer candidates of my size and potentially more donated hearts that match my size, which explains why the Cedars-Sinai team feels that I will likely be getting offers sooner than later.