Survival Benefit of Heart Transplant Varies by Center

The allocation of donor hearts has long been controversial because of organ scarcity and the vulnerability of the U.S. allocation system to gaming, due partly to subjective criteria (e.g., decisions for pharmacological or mechanical hemodynamic support). In response, the Organ Procurement and Transplant Network revised its allocation criteria in 2018 from three to six levels and required cardiogenic shock for highest-priority status. These researchers assessed the estimated benefits of transplantation in 113 U.S. cardiac transplantation centers.

Of 29,199 wait-listed individuals (mean age, 62; 52% women), 19,815 underwent cardiac transplantation. Five-year survival was 77% among those receiving transplantation, compared with 33% among those …