{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T08:31:02Z","timestamp":1788251462204,"version":"build-2803163510"},"reference-count":12,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2020,5,19]],"date-time":"2020-05-19T00:00:00Z","timestamp":1589846400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Abigail Wexner Research Institute at Nationwide Children's Hospital"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Transplantation"],"published-print":{"date-parts":[[2020,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To understand current donor heart allocation practices for pediatric transplantation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Background<\/jats:title><jats:p>Despite high waitlist mortality rates among pediatric patients awaiting transplant, a substantial proportion of donor hearts go unused. Analysis of UNOS match run data may identify opportunities to optimize organ utilization.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Using UNOS\/OPTN data, we evaluated all match runs for pediatric (&lt;18\u00a0years) donor hearts from 1\/1\/2006 to 3\/31\/2017. We assessed final disposition of donor hearts, reasons for donor refusal, and other match run characteristics. Variation in total offers made per organ, and refusal rates by OPOs were also evaluated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 7585 pediatric potential donor hearts, 2226 (29.3%) were refused. Hearts accepted underwent a median of 2 offers (IQR: 1\u20105), compared to 11 (IQR: 5\u201024) for refused donor hearts. Organ refusal rates decreased from 36.9% in 2006\u20102009 to 22.3% in 2014\u20102017 (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.001). Reasons for refusal included quality (80.9%), size mismatch (57.5%), and known\/suspected crossmatch positivity (39.1%). Among 1800 hearts deemed \u201cpoor quality\u201d by \u22651 transplant program, less than half (46.6%) were coded \u201cpoor quality\u201d by multiple refusing programs. Organ refusal rates ranged from 13.5% to 83.3% across OPOs, and there was no correlation between refusal rates and median number of offers made by the OPO.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Although more organs are being used over time, 1 in 5 available pediatric donor hearts are still discarded. The lack of donor evaluation consensus and wide variability in donor refusal rates indicates a need for standardization of donor assessment and match run processes across OPOs.<\/jats:p><\/jats:sec>","DOI":"10.1111\/petr.13743","type":"journal-article","created":{"date-parts":[[2020,5,19]],"date-time":"2020-05-19T09:50:38Z","timestamp":1589881838000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Pediatric donor heart allocation in the United States, 2006\u20102017: Current patterns and potential for improvement"],"prefix":"10.1111","volume":"24","author":[{"given":"Jaclyn","family":"Giafaglione","sequence":"first","affiliation":[{"name":"Department of Pediatrics Nationwide Children\u2019s Hospital Ohio State University Columbus Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"Morrison","sequence":"additional","affiliation":[{"name":"Sanger Heart &amp; Vascular Institute Levine Children\u2019s Hospital Charlotte North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charitha","family":"Gowda","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases Department of Pediatrics Nationwide Children\u2019s Hospital Ohio State University Columbus Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Gajarski","sequence":"additional","affiliation":[{"name":"Division of Cardiology Department of Pediatrics Nationwide Children\u2019s Hospital Ohio State University Columbus Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0144-1433","authenticated-orcid":false,"given":"Deipanjan","family":"Nandi","sequence":"additional","affiliation":[{"name":"Division of Cardiology Department of Pediatrics Nationwide Children\u2019s Hospital Ohio State University Columbus Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,5,19]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.108.815712"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2008.02443.x"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/petr.13244"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2020.01.1345"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/petr.13216"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/tri.12835"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.12237"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2016.12.071"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/petr.12149"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.112.000029"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2017.03.002"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/petr.13034"}],"container-title":["Pediatric 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