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Implantation of Total Artificial Heart in Congenital Heart Disease
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Exception-Status Listing: A Critical Pathway to Heart Transplantation for Adults With Congenital Heart Diseases

Aniket S Rali1, Sagar Ranka2, Jeremy A Mazurek3

  • 1From the Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.

Journal of Cardiac Failure
|October 20, 2021
PubMed

Insights

Adults with congenital heart disease awaiting heart transplants can use exception-status listing for timely access. This vital pathway helps overcome limitations of conventional therapies and improves transplant access for complex cases.

Area of Science:

  • Cardiology
  • Transplantation Medicine
  • Congenital Heart Disease

Background:

  • Adults with congenital heart disease (ACHD) often face challenges with conventional therapies for ventricular systolic dysfunction.
  • Mechanical circulatory support can prioritize heart transplant recipients, leading to longer wait times and increased mortality for ACHD patients.
  • Exception-status listing offers a crucial pathway for listing complex ACHD patients for heart transplantation at appropriate priority levels.

Purpose of the Study:

  • To evaluate trends in the utilization of exception-status listing for adults with congenital heart disease (ACHD) on the heart transplant waitlist.
  • To assess the impact of changes in the organ allocation system on the use of exception-status listing for ACHD patients.
  • To highlight the importance of exception-status listing for ensuring timely heart transplantation access for ACHD.

Main Methods:

  • Utilized the United Network for Organ Sharing (UNOS) registry for data retrieval.
  • Analyzed trends in exception-status listing among adult congenital heart disease patients awaiting heart transplantation.
  • Examined the temporal relationship between exception-status listing trends and modifications to the organ allocation system.

Main Results:

  • An upward trend in the use of exception-status listing was observed among ACHD patients.
  • This uptrend in exception-status listing use was most pronounced following changes implemented in the organ allocation system.
  • Exception-status listing has become an increasingly vital pathway for ACHD patients needing heart transplants.

Conclusions:

  • Exception-status listing is a critical pathway for adults with congenital heart disease to access heart transplantation.
  • The use of exception-status listing has increased, particularly after recent updates to the organ allocation system.
  • This listing status is essential for ACHD patients whose waitlist mortality risks may not be adequately captured by standard criteria, ensuring timely access to transplants.

Keywords:
Heart transplantation allocation systemadults with congenital heart diseaseexception-status listingheart transplantation

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