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Listing patterns at the highest volume heart transplant centers: Multiple roads to transplant

Joshua A Rushakoff1, Adam D DeVore1, Richa Agarwal1

  • 1Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC.

JHLT Open
|February 2, 2026
PubMed

Insights

Heart transplantation (HT) waitlist status assignment varies significantly among top centers, impacting patient allocation. Understanding these practices is crucial for improving the organ distribution system and reducing waitlist deaths.

Area of Science:

  • Cardiology
  • Transplantation Medicine
  • Health Services Research

Background:

  • The current heart transplantation (HT) allocation system utilizes progressive statuses to prioritize high-risk patients and reduce waitlist mortality.
  • Variations in listing practices among transplant centers can influence patient access to organs.

Purpose of the Study:

  • To analyze the listing practices and final waitlist status distributions at the 10 highest-volume heart transplantation centers.
  • To identify variations in status assignment patterns across these leading centers.

Main Methods:

  • Utilized United Network for Organ Sharing (UNOS) thoracic organ data from October 18, 2018, to June 30, 2025.
  • Examined data from 5,466 total heart transplantations at the 10 highest-volume centers.

Main Results:

  • Significant variation observed in the distribution of final waitlist statuses (Status 1: 3.6%-16.4%; Status 6: 0.5%-14.5%) across centers.
  • Some centers exhibited even status distributions, while others predominantly assigned patients to Status 2.

Conclusions:

  • Center-specific practices in assigning heart transplantation waitlist statuses are diverse.
  • These practice variations must be considered when evaluating continuous distribution allocation models for heart transplantation.

Keywords:
Allocation systemCandidate evaluationHeart transplantationHighest-volume centersOrgan listing patterns

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