Exception Status Listing – A Critical Pathway to Heart Transplantation For Adults with Congenital Heart Diseases

Abstract Adults with congenital heart diseases may not be candidates for conventional therapies for ventricular systolic dysfunction including MCS which moves potential heart transplantation recipients to a higher priority listing status. This results in longer wait list times and mortality. Exception status listing allows for one pathway for this complex and anatomically heterogenous group of patients to be listed for heart transplantation at appropriately high listing status. Our study queried the United Network for Organ Sharing (UNOS) registry to evaluate trends in utilization of exception status listing amongst adults with congenital heart diseases awaiting heart transplantation. While uptrend in utilization of exception status listing precedes the new allocation system, it been greatest since change in allocation system. It continues to remain a vital pathway in allowing adults with CHD, whose waitlist mortality is often not adequately characterized using the waitlist status criteria, timely access to heart transplantation