Variability in Donor Selection among Pediatric Heart Transplant Providers - Results from an International Survey

Godown, Justin; Kirk, Richard; Joong, Anna; Lal, Ashwin K.; McCulloch, Michael A.; Peng, David M.; Scheel, Janet; Davies, Ryan R.; Dipchand, Anne I.; Miera, Oliver; Gossett, Jeffrey G.

doi:10.1016/j.healun.2019.01.430

Cited by 13 publications

(25 citation statements)

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“…Donor selection biases may also partially explain the lack of benefit after criteria revision on CHD transplantation rates and waitlist mortality. Recent data suggest that centers vary their donor selection criteria based on recipient and programmatic factors . Thus providers may be more selective in accepting an organ for a sicker CHD candidate, thereby prolonging waitlist durations and potentially increasing waitlist mortality.…”

Section: Discussionmentioning

confidence: 99%

Impact of the 2016 revision of US Pediatric Heart Allocation Policy on waitlist characteristics and outcomes

Magnetta

Godown

West

et al. 2019

American Journal of Transplantation

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US Pediatric Heart Allocation Policy was recently revised, deprioritizing candidates with cardiomyopathy while maintaining status 1A eligibility for congenital heart disease (CHD) candidates on “high‐dose” inotropes. We compared waitlist characteristics and mortality around this change. Status 1A listings decreased (70% to 56%, P < .001) and CHD representation increased among status 1A listings (48% vs 64%, P < .001). Waitlist mortality overall (subdistribution hazard ratio [SHR] 0.96, P = .63) and among status 1A candidates (SHR 1.16, P = .14) were unchanged. CHD waitlist mortality trended better (SHR 0.82, P = .06) but was unchanged for CHD candidates listed status 1A (SHR 0.92, P = .47). Status 1A listing exceptions increased 2‐ to 3‐fold among hypertrophic and restrictive cardiomyopathy candidates and 13.5‐fold among dilated cardiomyopathy (DCM) candidates. Hypertrophic (SHR 6.25, P = .004) and restrictive (SHR 3.87, P = .03) cardiomyopathy candidates without status 1A exception had increased waitlist mortality, but those with DCM did not (SHR 1.26, P = .32). Ventricular assist device (VAD) use increased only among DCM candidates ≥1 years old (26% vs 38%, P < .001). Current allocation policy has increased CHD status 1A representation but has not improved their waitlist mortality. Excessive DCM status 1A listing exceptions and continued status 1A prioritization of children on stable VADs potentially diminish the intended benefits of policy revision.

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Section: Discussionmentioning

confidence: 99%

Impact of the 2016 revision of US Pediatric Heart Allocation Policy on waitlist characteristics and outcomes

Magnetta

Godown

West

et al. 2019

American Journal of Transplantation

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“…In highly sensitized recipients, recent data suggests that there is no standardized approach to transplantation. 121,122 The requirement for a negative prospective crossmatch in this group has been demonstrated to result in longer waitlist times and inferior outcomes following listing. 123 Decision model analysis favors acceptance of the first organ regardless of sensitization, but this might not be true of all recipients, some of whom may be able to safely wait for a matched donor.…”

Section: Electrocardiogram (Ecg)mentioning

confidence: 99%

“…In a recent anonymous survey of pediatric heart transplant specialists, 48% explicitly acknowledge that concerns about regulatory bodies affect their donor decision-making. 122 Conclusions and recommendations…”

Section: Regulatory Oversightmentioning

confidence: 99%

ISHLT consensus statement on donor organ acceptability and management in pediatric heart transplantation

Kirk

Dipchand

Davies

et al. 2020

The Journal of Heart and Lung Transplantation

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“…[26][27][28] 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 Beginning in June 2020, ACTION began hosting a multi-institutional donor review virtual conference to discuss refused/accepted donor offers.…”

Section: Data Collectionmentioning

confidence: 99%

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

Hollander

Nandi

Bansal

et al. 2020

Pediatric Transplantation

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The number of children needing heart transplantation (HT) continues to rise. 1 Although improvements in heart failure (HF) therapy, particularly durable mechanical support, have improved waitlist outcomes, much work remains to be done. Firstly, the number of children who die while waiting for a suitable donor organ remains high. Currently, around 13% children and 25% of infants on the HT waitlist will not survive to transplantation. 2 Among those who do survive to transplant, waitlist characteristics, including waitlist duration, available mechanical support options, and renal injury all contribute to post-transplant outcomes. 3-8 The waitlist phase of care has received considerable attention recently, including the recent publication of an International Society for Heart & Lung Transplantation (ISHLT) consensus statement on donor organ acceptability and other important papers. 9-19 Given that the unacceptably high waitlist mortality rate is likely a result of cumulative effect of several inefficiencies in care along the heart failure-transplant trajectory, multiple interventions at various

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Variability in Donor Selection among Pediatric Heart Transplant Providers - Results from an International Survey

Cited by 13 publications

References 0 publications

Impact of the 2016 revision of US Pediatric Heart Allocation Policy on waitlist characteristics and outcomes

Impact of the 2016 revision of US Pediatric Heart Allocation Policy on waitlist characteristics and outcomes

ISHLT consensus statement on donor organ acceptability and management in pediatric heart transplantation

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

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