Assessing the Relationship Between Pediatric Donors’ Terminal Hospitalizations and Heart Acceptance Practices

Pediatric donor heart utilization variability among organ procurement organizations

“…In our cohort, blood pressures were abnormal greater than 40% als is an important predictor of subsequent refusals for an offered organ, suggesting behavioral economics likely plays a significant role in whether an offer is accepted. 24 As shown in the Shapley plot (Figure 1B), a higher sequence number predicts less likelihood of acceptance, suggesting reluctance to accept organs previously declined by other listing centers. Listing center code ranked third in predicting organ acceptance, raising the possibility that the variability observed in OPO HUR is most closely related to the acceptance practice of the listing centers receiving the offers.…”

Partial heart transplantation: A procedure still finding its place

“…Several recent studies have suggested that there is an ample supply of hearts that remain unallocated after exhausting the match run, many of which have functioning valves appropriate for PHT. 4,5 If the valves used for PHT are sourced solely from this "rejected" supply then PHT will utilize these otherwise non-allocated organs for good. However, should demand for this procedure increase and/or the donor supply of rejected hearts with functioning valves decrease, it would be difficult to argue that children in need of PHT should be given equal consideration for donor hearts than those in need of complete HT given the availability of a non-transplant option for these patients versus an infant heart transplant waitlist mortality of 23%.…”

“…Moreover, given that nearly all HLHS patients will need complete HT later in life and it is nearly certain that PHT induces anti‐human leukocyte antibody presensitization, do the benefits of this procedure justify the potential for more difficult donor‐recipient matching or worsened post‐transplant outcomes in the future? How will we incorporate PHT into our current organ allocation system while adhering to our shared principles of fair and equitable organ stewardship? Several recent studies have suggested that there is an ample supply of hearts that remain unallocated after exhausting the match run, many of which have functioning valves appropriate for PHT 4,5 . If the valves used for PHT are sourced solely from this “rejected” supply then PHT will utilize these otherwise non‐allocated organs for good.…”

Improving pediatric donor heart utilization: The less we change, the more things will stay the same

“…The problem of donor heart underutilization is not new, with earlier publications reporting nearly 50% of pediatric hearts offered for transplantation going unallocated (the term "discarded" has fallen out of favor). 1 Although some of these refused organs are of inferior quality and should not be used for transplantation, our In the current issue of Pediatric Transplantation, McCulloch et al 3 analyzed over 30 000 pediatric heart offers in a 10 year contemporary cohort, finding that nearly 90% of offers are declined and 39% of offered hearts are not allocated. Importantly, they also report that nearly 63% of non-allocated hearts had a functionally normal echocardiogram, including nearly half of those rejected for "donor size or quality" and one-third rejected for "organ specific donor issues."…”

“…In the current issue of Pediatric Transplantation , McCulloch et al 3 . analyzed over 30 000 pediatric heart offers in a 10 year contemporary cohort, finding that nearly 90% of offers are declined and 39% of offered hearts are not allocated.…”