- Rossano J.W.
- Dipchand A.I.
- Edwards L.B.
- Goldfarb S.
- Kucheryavaya A.Y.
- Levvey B.J.
- et al.
The Reality of the Current Dataset and Model
An Informal View of Our Specialty
The Currently Proposed New Program Metrics
- 1.The waiting list mortality rate ratio describes the risk of death once candidates are listed but before they undergo transplantation. The waiting list mortality rate ratio estimates the program's waiting list mortality relative to the national expectations.
- 2.The offer acceptance rate ratio indicates whether a program is more or less likely to accept offers than the national average. If the offer acceptance ratio is greater than 1.0, then the program tends to accept more offers than average; if the offer acceptance ratio is less than 1.0, then the program tends to accept fewer offers than average.
- 3.The 90-day graft survival hazard ratio provides an estimate whether the program has higher or lower than expected organ failure rates during the first 90 days after transplant compared with transplant outcomes for all US transplant programs. Organ failure numbers include organ failures, retransplantation, and patient deaths.
- 4.The 1-year graft survival conditional on 90-day graft survival hazard ratio provides an estimate of whether the program has higher or lower than expected graft failure rates during the first year after transplant.
Potential/Actual Consequences of Inaccurate Risk Modeling
What Can/Should We Do?
Conflict of Interest Statement
- 1.For the 4-year period, your total number of pediatric heart transplants was
- 2.For the 4-year period, the percentage of patients undergoing transplantation at your program with DCM was
- 3.For the 4-year period, the percentage of patients undergoing transplantation at your program with CHD was
- 4.For the 4-year period, the percentage of patients undergoing transplantation with single-ventricle heart disease (any stage of palliation, denominator is total number of transplants regardless of etiology of heart disease) was
- 5.For the 4-year period, how many patients were referred to you and evaluated for transplantation after being declined listing at another program?
- 6.On your first SRTR report from 2016 for 1-year patient survival, was the probability that the hazard ratio exceeded 1.2 greater than 0.75?
- 7.On your first SRTR report from 2016 for 1-year patient survival, was the O/E ratio
- 8.At any point in the past 10 years, has your center carried a center of excellence designation or other similar ranking (from any reimbursement entity, rating agency, or carrier)?
- 9.At any point in the past 4 years, has your center lost a center of excellence designation or other similar ranking or been downgraded by any reimbursement entity, rating agency, or carrier?
- 10.Your opinion regarding the current risk-adjustment model and SRTR pediatric heart transplant data reporting best fits which of the following responses? In answering this question, please assume an ideal situation in which change could be easily implemented.
- a)We are satisfied and think that nothing should be changed.
- b)We are dissatisfied and think that change is needed—report only based on DCM patients.
- c)We are dissatisfied and think that change is needed—creating a better risk model for all diagnoses and report based on all patients.
- d)We are dissatisfied and think that change is needed—create separate risk models for CHD and DCM and provide separate reports for each.
- Transplant outcomes for congenital heart disease patients bridged with a ventricular assist device.Ann Thorac Surg. 2018; 106: 588-594
- The Registry of the International Society for Heart and Lung Transplantation: nineteenth pediatric heart transplantation report—2016 focus theme: primary diagnostic indications for transplant.J Heart Lung Transplant. 2016; 35: 1186-1195
- Increasing complexity of heart transplantation in patients with congenital heart disease.Semin Thorac Cardiovasc Surg. 2016; 28: 487-497
- Comparing Scientific Registry of Transplant Recipients posttransplant program-specific outcomes ratings at listing with subsequent recipient outcomes after transplant.Am J Transplant. 2019; 19: 391-398
- https://optn.transplant.hrsa.gov/governance/public-comment/enhance-transplant-program-performance-monitoring-system/?Date accessed: October 15, 2021
- Association of low center performance evaluations and pediatric heart transplant center behavior in the United States.J Heart Lung Transplant. 2021; 40: 831-840
- Ethical issues in access, listing and regulation of pediatric heart transplantation.Transl Pediatr. 2019; 8: 278-283
- Variations in criteria and practices for heart transplantation listing among pediatric transplant cardiologists.Pediatr Cardiol. 2019; 40: 101-109
- Donor organ turn-downs after listing for pediatric heart transplant.J Heart Lung Transplant. 2019; 38: 241-245