{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,18]],"date-time":"2026-07-18T17:36:19Z","timestamp":1784396179794,"version":"3.55.0"},"reference-count":64,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2020,3,20]],"date-time":"2020-03-20T00:00:00Z","timestamp":1584662400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Transplantation"],"published-print":{"date-parts":[[2020,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Donor organ acceptance practices vary among pediatric heart transplant professionals. We sought to understand what is known about the interactions between the \u201chigh\u2010risk\u201d recipient and the \u201cmarginal donor,\u201d and how donor risk scores can impact this discussion.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A systematic review of published literature on pediatric HTx was undertaken with the assistance of a medical librarian. Two authors independently assessed search results, and papers were reviewed for inclusion.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We found that there are a large number of individual factors, and clusters of factors, that have been used to label individual recipients \u201chigh\u2010risk\u201d and individual donors \u201cmarginal.\u201d The terms \u201chigh\u2010risk recipient\u201d and \u201cmarginal donor\u201d have been used broadly in the literature making it virtually impossible to make comparisons between publications. In general, the data support that patients who could be easily agreed to be \u201csicker recipients\u201d are at more risk compared to those who are clearly \u201chealthier,\u201d albeit still \u201csick enough\u201d to need transplantation. Given this variability in the literature, we were unable to define how being a \u201chigh\u2010risk\u201d recipient interplays with accepting a \u201cmarginal donor.\u201d Existing risk scores are described, but none were felt to adequately predict outcomes from factors available at the time of offer acceptance.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>We could not determine what makes a donor \u201cmarginal,\u201d a recipient \u201chigh\u2010risk,\u201d or how these factors interplay within the specific recipient\u2010donor pair to determine outcomes. Until there are better risk scores predicting outcomes at the time of organ acceptance, programs should continue to evaluate each organ and recipient individually.<\/jats:p><\/jats:sec>","DOI":"10.1111\/petr.13665","type":"journal-article","created":{"date-parts":[[2020,3,21]],"date-time":"2020-03-21T04:38:40Z","timestamp":1584765520000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Review of interactions between high\u2010risk pediatric heart transplant recipients and marginal donors including utilization of risk score models"],"prefix":"10.1111","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9241-5219","authenticated-orcid":false,"given":"Jeffrey G.","family":"Gossett","sequence":"first","affiliation":[{"name":"University of California Benioff Children\u2019s Hospitals San Francisco CA 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