Projected Survival Benefit as Criterion for Listing and Organ Allocation in Heart Transplantation

Our analyses indicate that criteria other than severity of illness as measured by the probability of death are, in practice, dominant in the allocation of donated hearts for transplantation. High percentages of patients listed as well as those transplanted are not expected to undergo a substantial increase in probability of survival, and some are likely to be harmed. A survival benefit is anticipated only for severely ill patients. Estimation of the projected survival benefit of listing and of transplantation is feasible and may be used to prioritize patients and lead to the best use of donated organs.