Transplant Center Refusal Rate and Waitlist Outcomes in Pediatric Heart Transplantation

Purpose Approximately 40% of potential pediatric heart donations go unused, while waitlist mortality remains high. The aim of our study was to investigate associations between center refusal rate and waitlist outcomes. Methods Retrospective analysis was performed using UNOS/OPTN pediatric ( Results 5,639 listed patients in 59 centers met inclusion criteria. The lowest quartile of center had a median RR of 75th percentile had a RR ≥ 4. There was no association between RR quartile and transplant center volume (p=0.4). Centers in the highest RR quartile were more likely to remove patients from the waitlist due to death or clinical deterioration versus those at lowest RR quartile (24.1% vs 14.6%, p Conclusion Patients listed at high RR centers had worse survival from listing. High RR centers are more likely to remove patients from the waitlist due to death or clinical deterioration and are less likely to transplant patients. Refusal rate is not associated with center transplant volume.