ArticleCirculation. Heart failure2021
Exception Status Listing in the New Adult Heart Allocation System: A New Solution to an Old Problem?
Article in Circulation. Heart failure, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
9 citing papers in PubMed.
- High Rate of Transplantation Before Review of Status Exception Requests Among Adult Heart Transplant Candidates.Circulation. Heart failure · 2026Article
- Risk prediction model for waitlist mortality in patients with left ventricular assist devices.JHLT open · 2025Article
- High Rate of Transplantation Prior to Review of Status Exception Requests among Adult Heart Transplant Candidates.medRxiv : the preprint server for health sciences · 2025Article
- National Organ Procurement and Transplant Network Heart Allocation Policy: 6 Years Later.Circulation. Heart failure · 2025Review
- Are exceptions justified in the current heart allocation system?JHLT open · 2023Article
- Association of high-priority exceptions with waitlist mortality among heart transplant candidates.The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation · 2023Article
- Impact of the 2018 UNOS Heart Transplant Policy Changes on Patient Outcomes.JACC. Heart failure · 2023Review
- Critically appraising the 2018 United Network for Organ Sharing donor allocation policy: adding life boats or rearranging the deck chairs?Current opinion in anaesthesiology · 2022Review
- Impact of Temporary Percutaneous Mechanical Circulatory Support Before Transplantation in the 2018 Heart Allocation System.JACC. Heart failure · 2022Article
Corrections and comments
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Authors and funding
15 authors.
Funding
Abstract
backgroundOne of the goals of the revised 6-tiered US adult heart allocation policy was to improve risk stratification of patients to lower exception status utilization for transplant listing. We sought to define the characteristics and outcomes of waitlisted patients using exception status and to examine region- and center-level differences in utilization of exception status in the new heart allocation system.
methodsThis retrospective cohort analysis of the United Network for Organ Sharing database included adult waitlisted patients for heart transplant between October 18, 2018, and June 30, 2020, in the United States, stratified by use of exception status versus standard criteria.
resultsOut of 6351 patients, 1907 (30.0%) were waitlisted under exception status. Patients using exception status were more likely to have a nonischemic cause of heart failure, blood type O, United Network for Organ Sharing status 2 at listing and were less likely to have a durable left ventricular assist device at listing. Exception status utilization varied significantly between and within United Network for Organ Sharing regions. Listing by exception criteria was associated with a significantly higher incidence of heart transplantation compared with listing by standard criteria (hazard ratio, 1.25 [1.15-1.38],
conclusionsThe status tiers of the new heart allocation system may not fully capture medical urgency and complexity of waitlisted patients as assessed by transplant physicians and review committees and may limit the ability to develop a heart allocation score.
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