Is the practice of using oversized organs for recipients with elevated pulmonary vascular resistance justified?

Commentary: The illogic of oversizing donor hearts for pulmonary hypertension

“…4 A study of 3215 pediatric heart transplant recipients from the Organ Procurement and Transplant Network database found predicted left ventricular mass no better metric than weight alone in the pediatric population, and similar findings that oversizing does not confer advantage, but undersizing donor hearts carry a greater risk of mortality. 5 Thangappan and colleagues, 6 in this issue of the Journal, return to simple weight ratio instead of heart mass predictors to again challenge the practice of transplanting oversized donor hearts into pediatric recipients with pulmonary hypertension. The study uses the United Network for Organ Sharing registry data to assess 1491 patients, with attention to posttransplant outcomes for recipients with elevated pulmonary resistance.…”