Impact of Center Volume on the Use of Status 2 Exceptions for Heart Transplantation

OBJECTIVE: There are limited data examining the relationship between transplant center volume and their use of Status 2 exceptions for heart transplant (OHT). METHODS: A retrospective review of the Organ Procurement and Transplantation Network (OPTN) database identified all patients undergoing OHT under Status 2 exception between late 2018 and early 2023. Demographics were collected and transplant centers were categorized based on the number of OHT performed annually (very low volume = < 5 OHT per year; low volume = 5-24 OHT per year; medium volume = 25-50 OHT per year, high volume = > 50 OHT per year). RESULTS: Across all centers, 6348 OHT were included, with n = 68 performed at very low volume centers, n = 1001 performed at low volume centers, n = 1834 performed at medium volume centers, and n = 3445 performed at high volume centers. Medium and high volume centers applied for at least one Status 2 exception about 30%-35% of the time, compared to 50%-60% of the time observed at very low and low volume centers. Compared to very low volume centers, medium volume centers applied for half the amount of Status 2 exceptions (IRR = 0.52 [0.35-0.76]; p < 0.001) while high volume centers applied for less than half the amount (IRR = 0.42 [0.29-0.62]; p < 0.001). High-volume centers were also 18% less likely to apply for exceptions than medium-volume centers (IRR = 0.82 [0.74-0.91]; p < 0.001). CONCLUSIONS: Lower volume transplant centers apply for Status 2 exceptions at a significantly higher rate, with a stepwise decrease in exception use with increasing transplant center volume.