Variations in Criteria and Practices for Heart Transplantation Listing Among Pediatric Transplant Cardiologists

Angira Patel*, Kelly Michelson, Adin Cristian Andrei, Elfriede Pahl, Jeffrey G. Gossett

*Corresponding author for this work

Research output: Contribution to journalArticle

3 Scopus citations

Abstract

Ethical issues in pediatric heart transplantation (Htx) include resource allocation, benefit, and burden assessment in high-risk recipients, and informed consent. Practice patterns and decision-making was investigated using an internet survey with 47-multiple choice items and vignette-based questions. Of 43 pediatric Htx cardiologists contacted, 28 (65%) responded. Respondents reported that an overall median 1-month survival of 73% (range 50–100%), 1-year survival of 70% (range 50–85%), 5-year survival of 50% (range 40–85%), and 10-year survival of 50% (range 25–85%) was adequate to offer Htx. Based on vignettes presented, 100% of those surveyed would offer Htx to a straightforward 12-year old with end-stage dilated cardiomyopathy and a 7-year old with hypoplastic left heart syndrome with protein losing enteropathy. Thirty percent of physicians would offer Htx to a patient status post a Fontan procedure with mutliple co-morbidities. Seventy-five percent of physicians would offer Htx despite proven non-adherence. Considerable variability exists in the practice patterns of pediatric heart transplant cardiologists with regards to decision-making while evaluating patients for listing. Disagreements among pediatric Htx cardiologists exist when there are concerns for non-adherence and associated multiple co-morbidities. Further work is needed to understand these variations and develop consensus for pediatric Htx organ allocation.

Original languageEnglish (US)
Pages (from-to)101-109
Number of pages9
JournalPediatric cardiology
Volume40
Issue number1
DOIs
StatePublished - Jan 15 2019

Keywords

  • Ethics
  • Heart transplantation
  • Pediatric

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Cardiology and Cardiovascular Medicine

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