In The Heart of Change, the authors have culled from hundreds of interviews the 34 most instructive and vivid accounts of companies undergoing large-scale change.With chapters organized by each of the eight stages of change Kotter identified in Dr. John Kotter’s 1996 bestseller Leading Change, the authors deftly contrast success stories with fumbles, then utilize the compare-and-contrast. Kotter, John P., and Dan S. The Heart of Change.Boston, MA: Harvard Business School Press, 2002. In 1996, John P. Download avast antivirus for windows 10 full version with key. Office 2016 mac license installer. Kotter's Leading Change became a runaway best seller, outlining an eight-step program for organizational change that was embraced by executives around the world. Then, Kotter and co-author Dan Cohen's The Heart of Change introduced the revolutionary 'see-feel-change' approach, which helped executives understand the crucial role of emotion in successful change efforts. The Heart of Change by John P. Kotter and Dan S. Cohen Harvard Business School Press Book, Boston 'People change what they do less because they are given analysis that shifts their thinking than because they are shown a truth that influences their feelings.' John Kotter Step 1: Increase Urgency Step 2: Build the Guiding Team.

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FEATURE ARTICLE
Effects of the 2006 U.S. thoracic organ allocation change: Analysis of local impact on organ procurement and heart transplantation Jose N. Nativi, MD,a,b Abdallah G. Kfoury, MD,a,c Craig Myrick,d Melissa Peters,d Dale Renlund, MD,a,b,c Edward M. Gilbert, MD,a,b,e Feras Bader, MD,a,b,e Arun K. Singhal, MD,a,b Melanie Everitt, MD,a,f Patrick Fisher, DO, PhD,a,c David A. Bull, MD,a,b,e Craig Selzman, MD,a,b and Josef Stehlik, MD, MPHa,b,e From the aU.T.A.H. Cardiac Transplant Program, b University of Utah Health Sciences Center, c Intermountain Medical Center, d Intermountain Donor Services, e George E. Wahlen Veterans Affairs Medical Center and f Primary Children’s Medical Center, Salt Lake City, Utah.
KEYWORDS: organ procurement; organ donation; heart transplantation; transplant waiting list; waiting list mortality
BACKGROUND: The United Network for Organ Sharing (UNOS) implemented a thoracic organ allocation policy change (APC) in July 2006 that aimed to reduce death on the waiting list by expanding regional organ sharing. As such, organs would be allocated to the sickest recipients with highest listing status across the region. Our aim was to determine the impact of the new policy on the procurement and transplant process within our program. METHODS: We analyzed data supplied by UNOS as the contractor for the Organ Procurement and Transplantation Network and from the local organ procurement organization for 2 years before and 2 years after implementation of the APC. RESULTS: The APC resulted in an increase in the proportion of Status 1A patients transplanted (24% to 43%, p ⫽ 0.015) and a decrease in the proportion of Status 2 patients transplanted (56% to 24%, p ⫽ 0.001). Significant increases were observed in mean graft ischemic time (196 minutes to 223 minutes, p ⫽ 0.022), number of patients transplanted with ventricular assist devices (17% to 31%, p ⫽ 0.036), and procurement costs. There was no significant difference in waiting-list mortality (6% to 5%, p ⫽ 0.75) and short-term post-transplant survival. CONCLUSIONS: The 2006 change in UNOS organ allocation policy resulted in an increase in Status 1A transplants, graft ischemic time and procurement costs, and a decrease in Status 2 transplants, but no effect on mortality on the waiting list within our center. To assess the full effect of the APC on outcomes, the long-term impact of the increased graft ischemic time on survival should be quantified. J Heart Lung Transplant 2010;29:235–9 © 2010 International Society for Heart and Lung Transplantation. All rights reserved.
Reprint requests: Josef Stehlik, MD, Department of Cardiology, University of Utah Health Sciences Center, 50 North Medical Drive, 4A100 SOM, Salt Lake City, UT 84132. Telephone: 801-582-1565 (x4543). Fax: 801-584-2532. E-mail address: [email protected]
The United Network for Organ Sharing (UNOS) is contracted by the federal government to provide a system for equitable distribution of all organs available for transplantation in the USA.1,2 To achieve this objective in heart and lung transplantation, UNOS created the Thoracic Organ
1053-2498/10/$ -see front matter © 2010 International Society for Heart and Lung Transplantation. All rights reserved. doi:10.1016/j.healun.2009.05.036
236 Table 1
The Journal of Heart and Lung Transplantation, Vol 29, No 3, March 2010 Sequence of Adult Heart Allocationa
Before July 2006
After July 2006
Local 1. Status 1A candidates 2. Status 1B candidates 3. Status 2 candidates Zone A 4. Status 1A candidates 5. Status 1B candidates Zone B 6. Status 1A candidates 7. Status 1B candidates Zone A 8. Status 2 candidates Zone B 9. Status 2 candidates Zone C 10. Status 1A candidates 11. Status 1B candidates 12. Status 2 candidates
Local 1. Status 1A candidates 2. Status 1B candidates Zone A 3. Status 1A candidates 4. Status 1B candidates Local 5. Status 2 candidates Zone B 6. Status 1A candidates 7. Status 1B candidates Zone A 8. Status 2 candidates Zone B 9. Status 2 candidates Zone C 10. Status 1A candidates 11. Status 1B candidates 12. Status 2 candidates
Zones are determined by the distance from donor hospital to transplant hospital: Zone A, ⱕ500 nautical miles; Zone B, 500 –1,000 nautical miles; Zone C, ⬎1,000 nautical miles. a Adapted from UNOS Policy 3.7.10.
Committee, which embraces a multidisciplinary group of professionals responsible for the design and monitoring of thoracic organ allocation algorithms. The first algorithm for the allocation of donor hearts was a 7-tiered medical urgency category system, similar to kidney allocation models. In 1989, the algorithm was simplified and included only two medical urgency categories, Status 1 and Status 2. The major limitation of this system was the inability to allocate organs preferentially to the most critically ill patients. To overcome this limitation, an allocation policy change in 1999 introduced Status 1A and Status 1B.3 On July 1, 2006, the most recent thoracic organ allocation policy change (APC) was implemented. It provides for regional sharing of organs for the most medically urgent patients.4 Under the new policy, hearts are offered to candidates in Status 1A and Status 1B locally and then regionally (up to a distance of 500 miles from the donor hospital), and subsequently to local candidates in Status 2. Statistical modeling of the waiting list had shown that the most medically urgent patients, those in Status 1A and 1B, benefit the most from heart transplantation.5–7 The new policy is predicted to reduce waitinglist mortality.8 Before 2006, donor hearts were offered first to local Status 1A patients, then 1B and 2 sequentially. If an appropriate recipient could not be located among those waiting locally, then the heart was offered regionally. Table 1 compares the old and the new allocation algorithms. The Utah Transplant Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program includes four transplant centers: Intermountain Medical Center (previously LDS Hospital); Primary Children’s Medical Center; University of
Utah Health Sciences Center; and the George E. Wahlen Veterans Affairs Medical Center. This program is a member of the UNOS Geographic Region 5 and has followed the new allocation system since July 2006. After 2 years of implementation, the full effects of the new APC are unknown. Our aim was to determine the impact the new allocation policy had on the procurement process, procurement cost, waiting-list mortality, and recipient outcomes.
Methods Patients The study included all patients who underwent heart transplantation in the U.T.A.H. Cardiac Transplant Program. Two eras were selected for comparison, the 2-year era immediately before the APC (from July 1, 2004, to June 30, 2006) and the 2-year era immediately after the APC (from July 1, 2006, to June 30, 2008). Clinical information was supplied by UNOS as the contractor for the Organ Procurement and Transplantation Network (OPTN) and the procurement and cost information was obtained from Intermountain Donor Services, the local organ procurement organization (OPO). The study was approved by the institutional review board.
Figure 1 UNOS status at transplantation before and after thoracic organ allocation policy change (based on Organ Procurement and Transplantation Network data).
Nativi et al.
Effects of

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