6. Conclusion

The 2018 UNOS allocation system is rooted in the 2006 allocation reflects the evolution of the practice of heart failure since explosion of mechanical circulatory support. This next iteration of the allocation system focuses on present era mortality rates among like pools of candidates and seeks to improve regional sharing for more acute patients. It seeks to reduce waiting list mortality rates by allocating organs to the most critically ill candidates, rectify issues with specific patients groups, and incorporate broader geographic sharing to optimize access and limit regional disparities while keeping post-transplant survival (within each status) comparable to the current system. Future allocation systems will likely evolve toward a global heart allocation score.
