Heart Transplant Triage: Reading Organs, Not Just Pumps

Key Takeaway

A registry study of 38,012 adult US heart transplant candidates built an objective urgency score from 5 lab values and 4 heart-support devices. It predicted who would die within 6 weeks without a transplant better than the current 6-status system (mean AUC 0.807 vs 0.693). In simulation, it moved donor hearts toward candidates with a higher risk of dying while they waited.

Two Patients, One Heart, Six Weeks

Picture two people waiting for the same donor heart. The first has a temporary pump threaded into her chest. On paper, that device puts her near the top of the list. The second relies on a durable implanted pump and looks steadier by the rulebook. Yet his kidneys are faltering and his liver labs are drifting the wrong way. Today, the hardware usually wins. Each year, roughly 1 in 5 US heart transplant candidates dies or is removed from the list without ever receiving a heart^[1]. The question of who goes first is a matter of life and death.

Since 2018, US donor hearts have been allocated through a 6-tier system. Each tier rests largely on the type…