Elevated Waitlist Mortality Persists in Pediatric Heart Transplantation

Revised Allocation Policy Fails to Show Significant Impact

Recent Analyses Raise Concerns

Despite decades of improvements in pediatric heart transplantation techniques, waitlist mortality (WM) remains concerningly high in this population. The United Network for Organ Sharing (UNOS) last revised its allocation policy for pediatric heart transplants in 2016, but recent multivariable analyses have failed to demonstrate a significant reduction in WM following these changes.

While the 2016 revisions aimed to prioritize sicker infants and children on the waitlist, the latest evidence suggests that they have had minimal impact on waitlist mortality. Researchers have found that the revised allocation system has not led to a substantial decrease in WM, potentially raising concerns about the effectiveness of the current policy.

Historical Challenges and Future Directions

Over the past 25 years, the method used to rank infants and children on the waitlist for heart transplants has undergone several revisions. Despite these changes, WM remains elevated, indicating that further refinements to the allocation system are necessary.

Ongoing research and collaboration among transplant professionals are crucial to identifying strategies that can effectively reduce waitlist mortality in pediatric heart transplantation. Future revisions to the allocation policy should be informed by rigorous data analysis and aim to optimize outcomes for all patients awaiting heart transplantation.