Disparities in organ acceptance practices exacerbate donor heart nonuse and lead to increased waiting times and mortality for heart transplant candidates. We studied disparities in donor heart acceptance among US transplant centers and their relations to posttransplant outcomes. Candidate, potential transplant recipient match run, and deceased donor data were obtained from the United Network for Organ Sharing. We analyzed donor, candidate, and transplant center characteristics with respect to organ acceptance, offer acceptance, number of offers before acceptance (organ sequence number), and association with posttransplant mortality. A total of 693 420 donor heart offers made between April 2007 and December 2015 were included. We identified great variability in donor heart acceptance practices among US heart transplant centers. We identified donor and recipient characteristics that were strongly associated with heart organ and offer acceptance, and organ sequence number, and identified inconsistencies among centers with respect to how these characteristics influenced acceptance decisions. Finally, we identified characteristics that were highly predictive of donor heart nonuse and were not associated with increased recipient mortality, which may guide future efforts aimed at increasing use of available hearts for transplantation.

中文翻译：

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美国各地捐赠心脏接受实践的巨大差异。

器官接受实践的差异加剧了供体心脏的不使用，并导致心脏移植候选人的等待时间和死亡率增加。我们研究了美国移植中心接受供体心脏的差异及其与移植后结果的关系。候选人、潜在的移植受者匹配运行和已故捐献者数据是从器官共享联合网络获得的。我们分析了捐赠者、候选者和移植中心在器官接受、报价接受、接受前报价数量（器官序列号）以及与移植后死亡率相关方面的特征。共包括 2007 年 4 月至 2015 年 12 月期间提供的 693 420 个捐献心脏报价。我们发现美国心脏移植中心在供体心脏接受实践方面存在很大差异。我们确定了与心脏器官密切相关的供体和受体特征，并提供了接受度和器官序列号，并确定了中心之间在这些特征如何影响接受决定方面的不一致。最后，我们确定了高度预测供体心脏未使用且与受体死亡率增加无关的特征，这可能指导未来旨在增加可用心脏用于移植的努力。