Heart failure & cardiomyopathiesCohort study
High Rate of Transplantation Before Review of Status Exception Requests Among Adult Heart Transplant Candidates
- Registry study using the Scientific Registry of Transplant Recipients
Authors' conclusion
More than 25% of patients with status exception requests receive heart transplants before their applications are even received by their RRBs, raising significant concerns about the fairness of retrospective review of exception requests for the allocation of donor hearts.
Study context
- Population
- Adult heart transplant candidates listed between October 18, 2018, and May 31, 2025, with submitted applications for status exceptionsadult candidates on whose behalf 138 transplant centers submitted status exception requests
- Participants
- 11,508 candidates
- Exposure
- Applications eventually approved vs denied
- eventual denialsn = 913
- approvalsn = 10,595
Main finding
As reported in the abstract
Candidates who received a denial at least once
913 (7.9%)
Observational data: associations, not effects.
Further findings
Transplant before the RRBs received applications
Cumulative incidence
| Outcome | eventual denials | approvals |
|---|---|---|
| Cumulative incidence of heart transplantation before application receipt · 2 weeks | 19.1% (95% CI 16.6%–21.7%) | 27.2% (95% CI 26.4%–28.0%) |
- Transplant before the regional review boards (RRBs) received applications — All patients
- Three thousand seven out of 11 508 (26.1%)
- Cumulative incidence of heart transplantation before application receipt: P <0.001
Time from obtaining status upgrades to application receipt by the RRBs
- Median time
- 3 days
Potential transplant recipients bypassed by candidates transplanted despite denied exceptions
- Bypassed potential transplant recipients
- more than 11 thousand
Original publication
Summarised from the published abstract; every number is checked against it