Author + information
- Received April 7, 2015
- Revision received July 6, 2015
- Accepted July 9, 2015
- Published online December 1, 2015.
- Raymond C. Givens, MD, PhD∗∗ (, )
- Todd Dardas, MD, MS†,
- Kevin J. Clerkin, MD∗,
- Susan Restaino, MD∗,
- P. Christian Schulze, MD, PhD∗ and
- Donna M. Mancini, MD∗
- ∗Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York
- †Division of Cardiology, University of Washington, Seattle, Washington
- ↵∗Reprint requests and correspondence:
Dr. Raymond C. Givens, Department of Medicine, Division of Cardiology, Columbia University Medical Center, 622 West 168th Street, New York, New York 10032.
Objectives This study sought to assess the association of multiple listing with waitlist outcomes and post–heart transplant (HT) survival.
Background HT candidates in the United States may register at multiple centers. Not all candidates have the resources and mobility needed for multiple listing; thus this policy may advantage wealthier and less sick patients.
Methods We identified 33,928 adult candidates for a first single-organ HT between January 1, 2000 and December 31, 2013 in the Organ Procurement and Transplantation Network database.
Results We identified 679 multiple-listed (ML) candidates (2.0%) who were younger (median age, 53 years [interquartile range (IQR): 43 to 60 years] vs. 55 years [IQR: 45 to 61 years]; p < 0.0001), more often white (76.4% vs. 70.7%; p = 0.0010) and privately insured (65.5% vs. 56.3%; p < 0.0001), and lived in zip codes with higher median incomes (US$90,153 [IQR: US$25,471 to US$253,831] vs. US$68,986 [IQR: US$19,471 to US$219,702]; p = 0.0015). Likelihood of ML increased with the primary center’s median waiting time. ML candidates had lower initial priority (39.0% 1A or 1B vs. 55.1%; p < 0.0001) and predicted 90-day waitlist mortality (2.9% [IQR: 2.3% to 4.7%] vs. 3.6% [IQR: 2.3% to 6.0]%; p < 0.0001), but were frequently upgraded at secondary centers (58.2% 1A/1B; p < 0.0001 vs. ML primary listing). ML candidates had a higher HT rate (74.4% vs. 70.2%; p = 0.0196) and lower waitlist mortality (8.1% vs. 12.2%; p = 0.0011). Compared with a propensity-matched cohort, the relative ML HT rate was 3.02 (95% confidence interval: 2.59 to 3.52; p < 0.0001). There were no post-HT survival differences.
Conclusions Multiple listing is a rational response to organ shortage but may advantage patients with the means to participate rather than the most medically needy. The multiple-listing policy should be overturned.
Supported by the Health Resources and Services Administration (contract 234-2005-370011C); research grants from the International Society for Heart and Lung Transplantation, and the Heart Failure Society of America (to Dr. Givens); and by grants from the National Heart Lung Blood Institute (K23 HL095742-01 and P30 HL101272-01 to Dr. Schulze). Dr. Dardas has received a research grant paid to his institution from the American College of Cardiology/Daiichi Sankyo Corp.; and a travel education grant paid to a third party from Heartware and Thoratec. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 7, 2015.
- Revision received July 6, 2015.
- Accepted July 9, 2015.
- American College of Cardiology Foundation