Association of high-priority exceptions with waitlist mortality among heart transplant candidates

Development and Validation of a Risk Score Predicting Death Without Transplant in Adult Heart Transplant Candidates

“…5 Waiting candidates are assigned a priority rank for each donor organ according to distance from the donor hospital, status, and waiting time. Despite a revision in October 2018 that expanded the number of statuses, the current heart allocation system is susceptible to manipulation from overtreatment and exception requests, [6][7][8] does not use important laboratory measures of illness severity, 9,10 and has only moderate predictive ability to rank order candidates according to medical urgency. 11 It is also unclear how the categorical 6-status system will be implemented in the forthcoming continuous distribution system, which will require a medical urgency score.…”

Optimizing Beneficence and Justice in Heart Transplant Allocation

“…However, this obligation to individual heart transplant candidates is at odds with the principle of justice, which promotes the distribution of donor organs in a fair and equitable manner. Even more concerning, while an individual physician might feel that petitioning for an exception request to list their patient at a higher urgency status than justified by established criteria might be in their patient’s best interests, exception candidates have approximately half the risk of waitlist mortality as standard candidates . Thus the physician, assuming they are appropriately advocating for their patient, may be actually unfairly prioritizing their patient at the expense of another.…”