Multiple Listing For Adult Heart Transplantation In The United States: Analysis Of Optn Data From 2000 To 2013

This study sought to assess the association of multiple listing with waitlist outcomes and post-heart transplant (HT) survival.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.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.We identified 679 multiple-listed (ML) candidates (2.0%) who were younger (median age, 53 years [interquartile range: 43 to 60 years] vs. 55 years [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 [US$25,471 to US$253,831] vs. US$68,986 [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% [2.3 to 4.7] vs. 3.6% [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.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.