Pediatric Cardiology

, Volume 40, Issue 1, pp 101–109 | Cite as

Variations in Criteria and Practices for Heart Transplantation Listing Among Pediatric Transplant Cardiologists

  • Angira PatelEmail author
  • Kelly Michelson
  • Adin-Cristian Andrei
  • Elfriede Pahl
  • Jeffrey G. Gossett
Original Article


Ethical issues in pediatric heart transplantation (Htx) include resource allocation, benefit, and burden assessment in high-risk recipients, and informed consent. Practice patterns and decision-making was investigated using an internet survey with 47-multiple choice items and vignette-based questions. Of 43 pediatric Htx cardiologists contacted, 28 (65%) responded. Respondents reported that an overall median 1-month survival of 73% (range 50–100%), 1-year survival of 70% (range 50–85%), 5-year survival of 50% (range 40–85%), and 10-year survival of 50% (range 25–85%) was adequate to offer Htx. Based on vignettes presented, 100% of those surveyed would offer Htx to a straightforward 12-year old with end-stage dilated cardiomyopathy and a 7-year old with hypoplastic left heart syndrome with protein losing enteropathy. Thirty percent of physicians would offer Htx to a patient status post a Fontan procedure with mutliple co-morbidities. Seventy-five percent of physicians would offer Htx despite proven non-adherence. Considerable variability exists in the practice patterns of pediatric heart transplant cardiologists with regards to decision-making while evaluating patients for listing. Disagreements among pediatric Htx cardiologists exist when there are concerns for non-adherence and associated multiple co-morbidities. Further work is needed to understand these variations and develop consensus for pediatric Htx organ allocation.


Heart transplantation Pediatric Ethics 



This study did not receive any funding.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

This article does not contain any studies with animals performed by any of the authors. This article does not contain any studies with human participants or animals performed by any of the authors. The survey was approved by our institutional review board.

Supplementary material

246_2018_1965_MOESM1_ESM.docx (21 kb)
Supplementary material 1 (DOCX 20 KB)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Northwestern Feinberg School of MedicineAnn & Robert H. Lurie Children’s Hospital of ChicagoChicagoUSA
  2. 2.Feinberg School of MedicineNorthwestern UniversityChicagoUSA
  3. 3.University of California San Francisco Benioff Children’s HospitalsSan FranciscoUSA

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