The United Network for Organ Sharing pediatric transplant list does not rank patients by medical need, according to a study published Aug. 5 in the Journal of the American College of Cardiology.
Stanford (Calif.) Medicine partnered with Stanford's Department of Economics and the University of Texas Southwestern School of Medicine in Dallas to compare how pediatric heart transplant candidates would have been ranked if medical need determined waitlist order.
The data analyzed in the study came from 12,408 infants and children younger than 18 who were on the pediatric heart transplant list between Jan. 20, 1999, and June 26, 2023.
Researchers organized the data into three groups based on time periods of UNOS allocation policy changes between 1996 and 2003, 2003 and 2016, and 2016 and 2023.
The study aimed to determine whether 2016 revisions to the UNOS allocation policy reduced waitlist mortality. The 2016 policy revisions grouped waitlisted patients into three categories of urgency: 1A, 1B and 2, with 1A being the category for patients who needed a transplant most urgently.
Researchers discovered instances where very sick children were in category 2 while less sick children were in category 1A. Researchers also found that less sick children who had been waiting longer were sometimes offered a heart transplant over sicker children, according to an Aug. 5 news release from Stanford Medicine.
Waitlist mortality decreased by 8% between 1996 and 2023, but researchers found the decline in deaths was attributable to improved medical care rather than organ allocation policy changes.
"The 2016 allocation revisions were not independently associated with the decline in pediatric heart transplant waitlist mortality," the study's authors wrote. "A more flexible allocation system that accurately reflects patient-specific risks and considers transplant benefit is urgently needed."