This US registry study developed and validated a heart transplant urgency score estimating 6-week mortality without transplant in adult candidates. The score incorporated five laboratory values and four therapeutic devices, including mechanical circulatory support. In test data, mean discrimination was higher than the current six-status system (AUC 0.807 versus 0.693). In allocation simulations, observed 6-week transplant-censored mortality among first-ranked candidates was 15.7% (95% CI, 13.9%-17.6%) with score-based allocation versus 11.2% (95% CI, 10.1%-12.5%) under the current system, indicating prioritization of higher-risk candidates rather than a demonstrated survival benefit.
The score improved short-term risk stratification and simulated prioritization of higher-risk transplant candidates. Whether implementation improves patient outcomes remains unestablished.
Study limitation: Registry-based prediction and simulated allocation do not establish the effects of implementing this policy on survival.
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