Association of low center performance evaluations and pediatric heart transplant center behavior in the United States

Boyle, Gerry; Rossano, Joseph W.; Scheel, Janet; Richmond, Marc E.; Arrigain, Susana; Schold, Jesse D.

doi:10.1016/j.healun.2021.04.008

Cited by 9 publications

(2 citation statements)

References 29 publications

(34 reference statements)

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“…Although OPTN oversight metrics recently added waitlist mortality, they have historically focused almost exclusively on post‐transplant outcomes, producing misguided incentives and risk aversion. This favors lower risk transplant candidates, decreased listing volumes in centers recently flagged for low center performance evaluations, 13 and potentially a tolerance for higher waitlist mortality. Our finding that the prior number of refusals was the most important variable impacting subsequent decisions is a classic example of an ‘information cascade’, 12 suggesting listing institutions are unduly influenced by the decisions of others, despite studies refuting the impact of prior number of refusals on pediatric heart transplant outcomes 14 .…”

Section: Discussionmentioning

confidence: 99%

Pediatric donor heart acceptance practices in the United States: What is really being considered?

McCulloch,

Alonzi,

White

et al. 2023

Pediatric Transplantation

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BackgroundRecent studies demonstrate high offer decline and organ non‐utilization rates are associated with increased pediatric heart transplant waitlist mortality. We sought to determine which donor, candidate, and offer specific variables most importantly influenced these decisions using only data available at the time of each offer.MethodsRetrospective review of pediatric (<18 years) heart donor offers made to pediatric candidates in the United States between 2010 and 2020. In addition to standard donor, candidate, and offer data available in UNOS, we extracted objective and qualitative valvar and myocardial function data from all available donor echocardiogram reports.ResultsDuring the study period, 5625 pediatric donor hearts produced 30 156 offers to 4905 unique candidates, of which 88.7% of all offers were declined and 39.2% of organs were not utilized by pediatric waitlisted candidates. Of the 60.8% utilized hearts, 89.7% had a ‘cumulatively’ normal echocardiogram at the time of offer acceptance; 62.9% of hearts not utilized for a pediatric candidate also had a cumulatively normal final echocardiogram. Random forest and logistic regression modeling demonstrated good predictive performance (AUROC ≥0.83) of likelihood to accept when utilizing donor, candidate, and offer specific variables. SHAP variable importance scores demonstrated number of prior offer declines and candidate institution's prior year acceptance rates as the two most important variables influencing offer decisions.ConclusionsBehavioral economics appear to play a significant role in pediatric heart transplant candidate institutions' acceptance practices, even when considering the arguably healthier pediatric donor population. Removal of prior institution's decisions from DonorNet may help increase donor utilization.

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Section: Discussionmentioning

confidence: 99%

Pediatric donor heart acceptance practices in the United States: What is really being considered?

McCulloch,

Alonzi,

White

et al. 2023

Pediatric Transplantation

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“…Everyone brings their own history and biases to this discussion and resources available at each institution may vary widely to help mitigate concerns. Additionally previous institutional experiences such as prior patient outcomes, personal history, and the recent focus on public reporting of outcomes, may impact individual clinicians and the entire team's willingness to place an individual patient on the transplant list 39 . Clearly given the implicit biases reported by the PHTS Healthcare Disparities Taskforce, as well as the systemic disparities we have been discussing, there is ample opportunity in this subjective process for bias to be introduced.…”

Section: Decision Making In Transplantationmentioning

confidence: 99%

Review on clinician bias and its impact on racial and socioeconomic disparities in pediatric heart transplantation

Amdani,

Gossett,

Chepp

et al. 2024

Pediatric Transplantation

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This expert review seeks to highlight implicit bias in health care, transplant medicine, and pediatric heart transplantation to focus attention on the role these biases may play in the racial/ethnic and socioeconomic disparities noted in pediatric heart transplantation. This review breaks down the transplant decision making process to highlight points at which implicit bias may affect outcomes and discuss how the science of human decision making may help understand these complex processes.

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Waitlist Outcomes for Children With Congenital Heart Disease: Lessons Learned From Over 5000 Heart Transplant Listings in the United States

Townsend

Karamlou

Boyle

et al. 2022

Journal of Cardiac Failure

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Association of low center performance evaluations and pediatric heart transplant center behavior in the United States

Cited by 9 publications

References 29 publications

Pediatric donor heart acceptance practices in the United States: What is really being considered?

Pediatric donor heart acceptance practices in the United States: What is really being considered?

Review on clinician bias and its impact on racial and socioeconomic disparities in pediatric heart transplantation

Waitlist Outcomes for Children With Congenital Heart Disease: Lessons Learned From Over 5000 Heart Transplant Listings in the United States

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