Heart failure & cardiomyopathiesCohort study
Development and Validation of an Adult Medical Urgency Score for US Donor Heart Allocation
- Registry-based observational study
- development and validation of an allocation score
- training, validation and test datasets
- match-run simulation
Authors' conclusion
In this registry-based study of US heart transplant candidates, a US-CRS-based allocation system prioritized sicker candidates with higher mortality without transplant compared with the current medical urgency statuses.
Study context
- Population
- All adult (aged ≥18 years) heart transplant candidates in the US organ transplant system, January 2019 to August 2025consecutive training, validation and test datasets, match-run analysis n = 45,530 donor hearts · training (2019-2023) 21,859 · validation (2023-2024) 7,897 · test (2024-2025) 8,256
- Exposure
- US-CRS-based allocation compared with the current 6-status system
Main finding
As reported in the abstract
Time-dependent AUC in test-set cross-sections
US-CRS
0.807
mean AUC
current 6-status system
0.693
mean AUC
Observational data: associations, not effects.
Further findings
| Outcome | US-CRS | current 6-status system |
|---|---|---|
| Match-run analysis: observed 6-week transplant-censored mortality for the first candidate on the match run | 15.7% (95% CI, 13.9%-17.6%) | 11.2% (95% CI, 10.1%-12.5%) |
- Match-run analysis: observed 6-week transplant-censored mortality for the first candidate on the match run — Transplant recipients moving down in rank order under a US-CRS-based system
- 67%
- Match-run analysis: observed 6-week transplant-censored mortality for the first candidate on the match run: n = 45 530 donor hearts
Original publication
Development and Validation of an Adult Medical Urgency Score for US Donor Heart Allocation. JAMA. Published 12 October 2026. doi:10.1001/jama.2026.17403
Summarised from the published abstract; every number is checked against it