{
  "abstract": "The US-candidate risk score (US-CRS) predicts waitlist mortality among heart transplant candidates using 7 laboratory, cardiovascular, and cardiac device usage variables on a 50-point scale, with higher scores indicating greater mortality risk. We assessed whether US-CRS accurately assigns mortality risk for exception candidates, and whether the alignment of allocation priority with waitlist mortality risk (US-CRS) differs between candidates with and without exceptions. We compared the performance of US-CRS in candidates with and without exceptions using receiver operating curves. We compared US-CRS distributions using the Kolmogorov-Smirnov (KS) test and examined the proportion of candidates below specific score thresholds in each group. We also compared candidates with and without exceptions using Wilcoxon Rank-Sum test for continuous variables and Pearson's Chi-squared test or Fisher exact test for categorical variables. US-CRS is accurate for measuring mortality risk among exception candidates as it is among non-exception candidates. Patients with higher waitlist status had higher median US-CRS. However, the median US-CRS of Status 1 candidates without exceptions (50 [IQR 48-50]) was significantly higher than for candidates with exceptions (45 [36-48]; [ p≤0.05 ]), and similarly for Status 2 (46 [41-49] vs. 42 [32-47]; [ p≤0.05 ]). Notably, 33.13% of Status 1 and 41.28% of Status 2 candidates with exceptions had US-CRS below 40, compared to only 1.84% and 19.20% of candidates without exceptions, respectively. Conversely, among candidates in Status 3 and 4, candidates with exceptions generally had higher US-CRS than candidates without exceptions. Allocation priority under the status system does not align with estimated mortality risk; misalignment is greater for candidates with exceptions. While some exception candidates in Status 1 and 2 do have high estimated mortality risk and legitimately need exceptions, many of these exceptions appear to have been granted to candidates with relatively low medical urgency.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Surgery, NYU Grossman School of Medicine, New York, New York.",
    "Department of Medicine, University of Minnesota, Minneapolis, Minnesota.",
    "Department of Cardiothoracic Surgery, NYU Grossman School of Medicine, New York, New York.",
    "Department of Medicine, University of Chicago, Chicago, Illinois."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 7,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Najiya Fatma"
    },
    {
      "affs": [
        0
      ],
      "name": "Suhani S Patel"
    },
    {
      "affs": [
        1
      ],
      "name": "Grace R Lyden"
    },
    {
      "affs": [
        2
      ],
      "name": "Nader Moazami"
    },
    {
      "affs": [
        2
      ],
      "name": "Brian Wayda"
    },
    {
      "affs": [
        3
      ],
      "name": "William F Parker"
    },
    {
      "affs": [
        0
      ],
      "name": "Sommer E Gentry"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/dg6z4k8jqkkym.bib",
  "cited_by": 0,
  "doi": "10.1016/j.jhlto.2026.100706",
  "fulltext_url": "https://europepmc.org/articles/PMC13744348",
  "id": "dg6z4k8jqkkym",
  "issns": [
    "2950-1334"
  ],
  "landing_url": "https://europepmc.org/article/MED/42999889",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2746|Transplantation: Methods and Outcomes"
    ]
  ],
  "openalex": "W7221522924",
  "pdf_url": "https://europepmc.org/articles/PMC13744348?pdf=render",
  "pmcid": "PMC13744348",
  "pmid": "42999889",
  "published": "2026-10-12",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/dg6z4k8jqkkym.ris",
  "sources": [
    {
      "first_seen": "2026-11-09T15:20:41Z",
      "native_id": "MED:42999889",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42999889"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2746|Transplantation: Methods and Outcomes",
      "subfield": "surgery"
    }
  ],
  "title": "Waitlist mortality risk (US-CRS score) distribution among status 1 and 2 adult heart transplant candidates with exceptions.",
  "title_text": "Waitlist mortality risk (US-CRS score) distribution among status 1 and 2 adult heart transplant candidates with exceptions.",
  "type": "peer-reviewed",
  "updated_at": "2026-11-09T15:20:41Z",
  "url": "https://research.draconitic.com/paper/dg6z4k8jqkkym",
  "venue": "JHLT open",
  "versions": []
}