Time for evidence-based, standardized donor size matching for pediatric heart transplantation

Abstract Intro Accurately predicting cardiac size by other body parameters has long been problematic for pediatric cardiac transplantation to determine if a donor heart will serve a given waitlist candidate, yet hundreds of heart donors are turned down annually for size mismatch. Objectives We sought to describe how donor body weight parameters are currently utilized in cardiac transplantation and its impact on waitlist outcomes. Methods From the United Network for Organ Sharing database, pediatric ( Results Overall median DCW was 200% [IQR 159%-241%]. Patients with congenital heart disease had higher DCW than those with cardiomyopathy (223% vs 203%; p 0.05). Subgroup analysis of critically ill children showed a waitlist survival advantage in those listed with a DCW ≥200% (p Conclusion Despite significant practice variation in acceptable donor weight in pediatric heart transplantation, patients listed with variable DCW ratios had similar post-transplant survival. However, in critically ill patients, a higher DCW ratio was associated with greater waitlist survival. Better understanding of the importance of donor weight could reduce practice variability and improve organ utilization and waitlist outcomes for cardiac transplant candidates.