Hospitals given latitude to select heart transplant candidates don’t always prioritize sickest patients

Analysis of more than 29,000 adults listed on the national heart transplant registry from 2006 to 2015 shows how rules that give hospitals discretion in determining who gets a transplant result in large discrepancies in how sick patients are when they receive heart transplants at hospitals across the United States.

The study, published on November 12 in the Journal of the American Medical Association (JAMA), focuses on a metric called survival benefit, which is the difference between a patient’s expected chance of survival after five years with a heart transplant versus without a transplant. Survival benefit is scored as the percentage increase in their chance of survival. Over the study period, the average survival benefit for heart transplants ranged from 30% at so-called low survival benefit hospitals to 55% at high survival benefit centers. Roughly one quarter of the 113 transplant centers studied were low benefit centers, and one quarter were high benefit centers.

Of the patients who received a heart transplant, the overall survival rate after transplant was similar across all centers, about 77%. The findings suggest that the high survival benefit hospitals are prioritizing sicker patients first, giving organs to those with lower chances of survival without a transplant, and thus boosting their survival benefit to a greater degree. Meanwhile the low survival benefit hospitals are playing it safe, giving organs to less critical patients who receive a smaller benefit from the transplant.

“These are all patients with end stage heart failure who have exhausted most of their options. They all need transplants, but there aren’t enough donor hearts to go around,” said William Parker, MD, MS, a pulmonologist and intensive care unit physician at the University of Chicago who led the study. “But the system is set up such that transplant centers have a lot of control over determining which patients receive top priority for transplant, which makes it a very nuanced problem.”


Originally published in The Forefront, 11/11/2019