High Status Heart program

Building upon the success of the interprovincial sharing of kidneys for highly sensitized patients, and guided by Canada's heart transplantation community, Canadian Blood Services has developed the technology to operationalize the goals of the approved interprovincial heart sharing policies to streamline and propel heart allocation and transplantation processes in Canada.

The Interprovincial organ sharing of hearts for high-status recipients program (referred to as the “IPOS Heart project”, "High Status Heart" or "HSH " ) is guided by the need to improve the allocation processes of a very rare and precious gift. The program’s focus is to match available hearts to the most medically urgent, and difficult to match heart waitlist patients. The program's policies are a result of a collaborative pan-Canadian stakeholder approach and provided an enhanced framework for balancing competing principles; while adding a national consistency, transparency, and accountability to the heart allocation process. 

Canadian Blood Services is honoured to work with, and inspired by, the many hard-working doctors, nurses, laboratory technicians, managers, analysts and software developers from coast-to-coast who are united in working on this "Made-in-Canada" project. 

 

Hearts for High Status Patients Dashboard

 

 

Program history  

Canadian Blood Services implemented the IPOS Heart program on October 12, 2023. 

Who is affected

The Canadian Transplant Registry (CTR) was developed to begin interprovincial matching and allocation of donor hearts to medically urgent (status 4) and highly sensitized (≥80% cPRA) candidates and improve the tracking of offers being made, the transplants, and the longer term outcomes of interprovincial organ sharing to these patient populations.  

How we got here

Building on foundational policy work done by the Canadian Cardiac Transplant Network (CCTN), the Heart Transplant Advisory Committee (HTAC), led by Canadian Blood Services, developed policies outlining a consistent national approach that defines eligibility and prioritization requirements for listing and interprovincial sharing of high status hearts (Medically Urgent and > = 80% cPRA). Today, heart transplant programs in Canada list all transplant candidates in Canadian Blood Services' CTR.

Interprovincial policies were first approved by provincial stakeholders for implementation within the CTR in January 2019, and CCTN have also updated their eligibility and listing criteria endorsing the use of these policies. In the intervening years prior to going live, the policies evolved based on clinical and administrative stakeholder needs.

As a interim measure, Virtual Crossmatch functionality was implemented in 2019 and to use in identifying those candidates that are known to be virtual crossmatch (vXM) negative to the donor heart being allocated. This helped reduce the allocation time of highly sensitized hearts, resulting in an immediately more efficient process for donor coordinators and reduced wait times for donor families.

What has been achieved

Prior to HSH, heart transplant candidates (of all medical statuses) were simply listed on the National Organ Waitlist (NOW). This meant that offering ODO coordinators had to manually scan the national list and determine for each heart candidate if they were a match with heir donor (ABO, age, weight, Hep B, Hep C, etc...). Then they had to figure out who they needed to offer to first. This was not efficient process and precious time was often wasted.
 

Today, the CTR does all the matching and ranking and produces a ranked list of candidates for the ODO coordinators to offer to. Supported by standardized interprovincial offering processes, the HSH allocation results list provides clarity and certainty when offering the heart and lessens administrative burdens. 

 

Current program status 

First anniversary activity

Click here to view or download a copy of the first year anniversary highlights.

Launched in October of 2023, the High-Status Heart program provides heart transplant patients who are in greatest need of assistance with priority access to available donors. This program is administered by Canadian Blood Services through the Canadian Transplant Registry in cooperation with provincial donation and transplant programs across Canada. 

Qualifying for the high-status heart program

  1. Patients whose need for a heart transplant is rated as having the highest level of medical urgency (medical status 4) 
  2. Patients who are estimated to be immunologically compatible with one in five available donors or fewer (highly-sensitized). 

Goals

  • Promoting interprovincial sharing and a national system
  • Ensuring organs are allocated fairly to the right recipients
  • Improving organ utilization (avoiding missed opportunities for transplant)

First year results

  • In the first year, 36 heart transplants were facilitated through the HSH program in its first year, 30 of which went to medically urgent recipients.
    • Status 4: 27
    • Highly-sensitized: 6
    • Both: 3
  • Heart transplants are typically performed in British Columbia, Alberta, Ontario, and Quebec. Within the first year of the program’s operation, 30 of the 36 transplants were performed in Ontario (14) and Quebec (16), with the remaining 6 transplants having been performed in Alberta.
  • More than 170 donors were made available to patients through the HSH program in its first year of operation
  • At any given time, there are 10 to 20 patients participating in the program who are awaiting a heart transplant.

 

“Efficiency has been greatly improved for organ matching and allocation as we are able to generate a list of potential recipients with a single click of a button.” 
– Organ Donation Organization Feedback

Support

Training

Virtual role based training sessions were held specific for ODO Coordinators, Recipient Coordinators, and Physicians. These sessions have been recorded and can be viewed here.

CTR Access

For heart coordinators or physicians who may need access to CTR , email the CTR Customer Support team at transplantregistry@blood.ca to arrange for user access and initial user training session, if possible, prior to attending IPOS HSH focused sessions.

Documents and Resources

IPOS Heart program documents, policies, and training resources in support of our provincial partners can be found by clicking here.

Engagement

Canadian Blood Services continues to work with all of our stakeholders through multiple lines of communication and various committees.

Contact

For any questions or concerns, please contact the Canadian Blood Services' IPOS team at ctr.ipos@blood.ca.