The method used across the United States to wait-list children for heart transplants does not consistently rank the sickest patients first, according to a new study led by Stanford Medicine experts.
Stanford Medicine Aug 28 2024 Adding nuance to the wait-list system by accounting for more health factors could reduce children's risk of dying while they await donor hearts, according to the study's authors. A revision to the way donor hearts are assigned is already in process. The study adds evidence for why it is needed, they said.
But the decline in deaths is due to improvements in medical care rather than the changes in how organs are allocated, the study found. “From the perspective of economics, we think about this fundamentally as an allocation problem,” Sweat said. “We’ve got this scarce resource of donor hearts, and we want to make sure they’re going to candidates who can get the most usage from them. In the case of pediatric heart transplantation, with such high wait-list mortality, what that usually looks like is you want to prioritize patients who are sicker.
Related StoriesHowever, the medical status of children within each of the three categories on the waitlist varied widely. In fact, the three categories showed significant overlap in the risk of mortality, the study found. In other words, some very sick children were categorized as priority 2 while others who were not as sick had a 1A status, meaning a less-sick child was sometimes offered a donor heart instead of a sicker child.
Rather, mortality decreased gradually from 1999 onward, driven by improvements to medical care, including advancements such as ventricular assist devices — mechanical pumps that support a child’s heart during the wait for transplant — and a better recognition of when to list a child for transplant. Over time, the gap in outcomes between patients of different races decreased, they found — a change that was linked to better outcomes overall.
Cardiology Children Heart Medicine Mortality
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