Transplant Center Variability in Organ Offer Acceptance and Mortality Among US Patients on the Heart Transplant Waitlist

Abstract

IMPORTANCEUnder the current Centers for Medicare & Medicaid Services guidelines, there is incentivization to optimize posttransplant outcomes regardless of mortality among patients on the waitlist and transplant rates; few data exist with regard to transplant center acceptance practices and survival to heart transplant.OBJECTIVES To evaluate the extent of variability in organ acceptance practices in the US and whether this center-level behavior is associated with heart transplant candidate survival. DESIGN, SETTING, AND PARTICIPANTSIn this retrospective cohort study, the US National Transplant Registry was queried for all match runs of adult candidates listed for isolated heart transplant between

Cocaine use in organ donors and long-term outcome after heart transplantation: An International Society for Heart and Lung Transplantation registry analysis

“…This rationale is consistent with a recent analysis of the United States National Transplant Registry between 2007 and 2017 by Choi et al, 12 showing that for every 10% increase in center acceptance rate, the risk of waitlist mortality decreased by 27%. We used the sequence number as a surrogate for center acceptance rate.…”

“…22,24 Whereas many risk factors have been associated with post-transplant survival, a perfect donor is rarely available, and each transplant center needs to decide its own policy about the use of marginal organs, including those from overdose-death donors. 12 Evidence shows that overdose-death donors are more likely to have a history of cocaine abuse and to be HCV antibody positive. 16 Although the reports of successful outcomes with anti-viral therapy in HCV-mismatched transplantation have been described, 25 there are legitimate concerns about accepting hearts from donors with a history of cocaine abuse.…”

A coordinated approach to improving pediatric heart transplant waitlist outcomes: A summary of the ACTION November 2019 waitlist outcomes committee meeting

“…17,29,30 This effect appears to be particularly evident in lower-volume programs, who are disproportionately penalized for each individual mortality, and has been shown to be more conservative with their donor acceptance practices, often to their detriment. 31,32 Beginning in June 2020, ACTION began hosting a multi-institutional donor review virtual conference to discuss refused/accepted donor offers. Each conference features 2-3 real-world cases in which a donor was either accepted or declined, followed by a discussion from all participants, including senior faculty members at high-volume institutions.…”

“…Although some offered organs are surely not suitable for transplantation, assessing a potential donor organ's quality is not standardized and the evaluation criteria often too strict 17,29,30 . This effect appears to be particularly evident in lower‐volume programs, who are disproportionately penalized for each individual mortality, and has been shown to be more conservative with their donor acceptance practices, often to their detriment 31,32 …”

“…All of this information is then placed into ACTION’s Learning Management System for access by all parties at any time using simple search terms. The ultimate goal of this project will be to increase waitlist survival through data‐driven organ quality assessment that will reduce inappropriate organ turndowns, which have been shown to increase waitlist mortality in both children and adults 32,33 . We believe this intervention will have the highest impact on low‐volume centers with low organ acceptance rates who will benefit from exposure to a wider array of donor decision scenarios.…”