Relationship Between Exception Request for Higher Listing Urgency and Aggressiveness in Accepting Heart Offers

Authors

Jorim Parmar, HCA HealthcareFollow
Yingxian Liu, HCA HealthcareFollow
Devika Adusumilli, HCA HealthcareFollow
Luke Taylor, HCA HealthcareFollow
Shakir Al-Ezzi, HCA HealthcareFollow
Usman Khan, HCA HealthcareFollow
Claudio Bravo, Medical City Heart & Spine
Claudius Mahr, HCA HealthcareFollow
Song Li, HCA HealthcareFollow

Files

Division

North Texas

Hospital

Medical City Arlington

Specialty

Internal Medicine

Document Type

Presentation

Publication Date

2026

Keywords

exception requests, heart transplant, transplant recipients

Disciplines

Cardiology | Cardiovascular Diseases | Internal Medicine | Medicine and Health Sciences | Surgical Procedures, Operative

Abstract

BACKGROUND: Transplant programs may submit exception requests to upgrade a listed patient’s priority, often anticipating a higher likelihood of accepting marginal or high-risk donor organs. This study explores whether exception request status is associated with increased risk tolerance in organ acceptance.

METHODS: We conducted a retrospective analysis using data from the Scientific Registry of Transplant Recipients (SRTR), focusing on adult patients (≥18 years) listed for heart transplantation. Statistical analyses were performed using SAS/STAT 14.1. Descriptive statistics summarized demographic and clinical variables. Baseline characteristics were compared between recipients with and without exception requests. Primary analysis: Mixed-effects linear regression was used to model continuous risk scores, incorporating a random intercept for transplant center and adjusting for recipient factors including age, sex, mechanical support devices, comorbidities, left ventricular hypertrophy, cardiac output, race, and HCV status. Secondary analysis: Logistic regression assessed the likelihood of accepting high-risk donor organs, defined by thresholds at the 75th, 80th, and 90th percentiles.

RESULTS: Among 20,543 heart transplant recipients, the average candidate age was 53.3 years (±12.8), with 72.9% male and 27.1% female. Racial distribution included 68.5% Caucasian, 25.6% Black, 4.0% Asian, 0.5% Multiracial, and 1.4% Other. Hispanic ethnicity accounted for 11.1% of candidates. Donor candidates had an average age of 33.0 years (±10.2) and an average ejection fraction of 61.8% (±6.8). The average recipient length of stay was 24.6 days (±27.4). Further analyses will explore stratified predictors of mortality, donor characteristics, and diagnostic indicators such as ejection fraction, wait time, and hospitalization duration.

CONCLUSION: This study aims to determine whether exception requests are associated with increased risk tolerance in organ acceptance, potentially informing transplant center practices and allocation policies.

Original Publisher

HCA Healthcare Graduate Medical Education

Recommended Citation

Parmar, Jorim; Liu, Yingxian; Adusumilli, Devika; Taylor, Luke; Al-Ezzi, Shakir; Khan, Usman; Bravo, Claudio; Mahr, Claudius; and Li, Song, "Relationship Between Exception Request for Higher Listing Urgency and Aggressiveness in Accepting Heart Offers" (2026). North Texas Research Forum 2026. 77.
https://scholarlycommons.hcahealthcare.com/northtexas2026/77