Heart failure & cardiomyopathiesCohort study
Rising Exception Requests in the Current Heart Allocation System
- Retrospective registry cohort study
- transplant registry analysis
- competing risks framework
- multilevel logistic regression
Authors' conclusion
The rising use of exceptions underscores ongoing limitations in allocation criteria, and disparities suggesting inequities in access to higher listing status.
Study context
- Population
- Adult isolated heart transplant candidates under the 2018 revised US heart allocation policy, October 18, 2018 to September 30, 2024
- Participants
- 26,330 participants
- Exposure
- Exception requests vs no exception requests
Main finding
As reported in the abstract
Exception request use
Candidates using exception requests
38.6%
More common among Black, non-Hispanic candidates and blood type O; less likely with blood type A
P < 0.001
Observational data: associations, not effects.
Further findings
Pretransplant isolated durable LV assist device
P < 0.001
Listed at status 1 or 2
Removed from waitlist at status 1 or 2
Original publication
Rising Exception Requests in the Current Heart Allocation System. JACC Heart Fail. Published 1 December 2025. doi:10.1016/j.jchf.2025.102776
Summarised from the published abstract; every number is checked against it