{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T15:50:32Z","timestamp":1791820232688,"version":"4.3.4"},"reference-count":32,"publisher":"American Medical Association (AMA)","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA"],"abstract":"\n Importance<\/jats:title>\n One in 5 heart transplant candidates in the US die or are delisted without transplant. Donor hearts are currently allocated by a 6-status therapy-based system criticized for limited risk stratification and susceptibility to gaming.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To develop a new heart allocation policy based on an objective medical urgency score that ranks candidates based on the interaction between physiology and mechanical circulatory support.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n Registry-based observational study using data from the US organ transplant system. All adult (aged \u226518 years) heart transplant candidates from January 2019 to August 2025 were included, split into training (2019-2023), validation (2023-2024), and test (2024-2025) datasets.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n A marginal structural model of 6-week mortality without transplant was estimated (the US Candidate Risk Score [US-CRS]). Eight models were compared in held-out data by weighted time-dependent area under the curve (AUC) and calibration by status. Finally, US-CRS was converted into an allocation policy and a match-run simulation of waitlist reordering was performed compared with the current 6-status system.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Adult heart transplant candidates were partitioned into consecutive training (n\u2009=\u200921\u202f859), validation (n\u2009=\u20097897), and test (n\u2009=\u20098256) datasets (mean [SD] age, 53 [13] years; 74% male). The chosen US-CRS model included 5 laboratory values and 4 therapeutic devices (durable left ventricular assist device, intra-aortic balloon pump, microaxial flow pump, and advanced mechanical circulatory support). In test-set cross-sections of candidates actively waiting on the same calendar date, US-CRS had similar or significantly higher time-dependent AUC than the current 6-status system (mean AUC, 0.807 vs 0.693, respectively) and acceptable calibration by status, especially for candidates who received their status by exception. In match-run analysis (n\u2009=\u200945\u202f530 donor hearts), a US-CRS\u2013based system led to 67% of transplant recipients moving down in rank order and increased observed 6-week transplant-censored mortality for the first candidate on the match run from 11.2% (95% CI, 10.1%-12.5%) under the current system to 15.7% (95% CI, 13.9%-17.6%) under the US-CRS\u2013based system.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this registry-based study of US heart transplant candidates, a US-CRS\u2013based allocation system prioritized sicker candidates with higher mortality without transplant compared with the current medical urgency statuses.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jama.2026.17403","type":"journal-article","created":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T15:30:29Z","timestamp":1791819029000},"source":"Crossref","is-referenced-by-count":0,"title":["Development and Validation of an Adult Medical Urgency Score for US Donor Heart Allocation"],"prefix":"10.1001","author":[{"given":"Grace R.","family":"Lyden","sequence":"first","affiliation":[{"name":"Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, Minnesota"},{"name":"Department of Medicine, University of Minnesota, Minneapolis"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Molly","family":"White","sequence":"additional","affiliation":[{"name":"Department of Medicine, The University of Chicago, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel J.","family":"Ahn","sequence":"additional","affiliation":[{"name":"Department of Surgery, Stanford University, Stanford, California"},{"name":"Stanford Transplant Outcomes Research Center, Stanford University, Stanford, California"},{"name":"Division of Cardiovascular Medicine, Stanford University, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"JonDavid","family":"Menteer","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Children\u2019s Hospital Los Angeles, Los Angeles, California"},{"name":"Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles"},{"name":"Heart Committee of the Organ Procurement and Transplantation Network, Rockville, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard C.","family":"Daly","sequence":"additional","affiliation":[{"name":"Heart Committee of the Organ Procurement and Transplantation Network, Rockville, Maryland"},{"name":"Department of Cardiothoracic Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikhil","family":"Narang","sequence":"additional","affiliation":[{"name":"Department of Medicine, The University of Chicago, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kiran K.","family":"Khush","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Stanford University, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carine","family":"Jasseron","sequence":"additional","affiliation":[{"name":"Agence de la Biom\u00e9decine, Direction Pr\u00e9l\u00e8vement Greffe Organes-Tissus, Saint-Denis La Plaine, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Dorent","sequence":"additional","affiliation":[{"name":"Agence de la Biom\u00e9decine, Direction Pr\u00e9l\u00e8vement Greffe Organes-Tissus, Saint-Denis La Plaine, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Masotti","sequence":"additional","affiliation":[{"name":"Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas L.","family":"Wood","sequence":"additional","affiliation":[{"name":"Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, Minnesota"},{"name":"Department of Medicine, University of Minnesota, Minneapolis"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica M.","family":"Colvin","sequence":"additional","affiliation":[{"name":"Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, Minnesota"},{"name":"Department of Cardiology, University of Michigan, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sommer E.","family":"Gentry","sequence":"additional","affiliation":[{"name":"Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, Minnesota"},{"name":"Department of Surgery, New York University Grossman School of Medicine, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William F.","family":"Parker","sequence":"additional","affiliation":[{"name":"Department of Medicine, The University of Chicago, Chicago, Illinois"},{"name":"Department of Public Health Sciences, The University of Chicago, Chicago, Illinois"},{"name":"MacLean Center for Clinical Medical Ethics, The University of Chicago, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2026,10,12]]},"reference":[{"issue":"2S1","key":"joi260104r1","doi-asserted-by":"publisher","first-page":"S329","DOI":"10.1016\/j.ajt.2025.01.024","article-title":"OPTN\/SRTR 2023 annual data report: heart.","volume":"25","author":"Colvin","year":"2025","journal-title":"Am J Transplant"},{"issue":"23","key":"joi260104r4","doi-asserted-by":"publisher","first-page":"2906","DOI":"10.1016\/j.jacc.2020.01.066","article-title":"Practice changes at US transplant centers after the new 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