OPTN/SRTR 2023 Annual Data Report: Heart

Monica M. Colvin^1,2, Jodi M. Smith^1,3, Yoon Son Ahn¹, Kelsi A. Lindblad⁴, Dzhuliyana Handarova⁴, Ajay K. Israni^1,5, Jon J. Snyder^1,6,7

¹Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN

²Department of Cardiology, University of Michigan, Ann Arbor, MI

³Department of Pediatrics, University of Washington, Seattle, WA

⁴Organ Procurement and Transplantation Network, United Network for Organ Sharing, Richmond, VA

⁵Department of Medicine, University of Texas Medical Branch, Galveston, TX

⁶Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN

⁷Department of Medicine, Hennepin Healthcare, University of Minnesota, Minneapolis, MN

Abstract

Despite unintended consequences and ongoing need for revision, the 2018 adult heart transplant policy revision continues to have a favorable impact as evidenced by increased transplant rates, decreased waitlist mortality, and more rapid transplant in higher acuity patients. In 2023, the total number of heart transplants in the United States increased 101.1% since 2012, reaching a record 4,599, of which 4,092 were performed in adults. Between 2022 and 2023 alone, 424 more adult heart transplants were performed, the largest annual increase this decade. Concurrently, the prevalence of heart donors after circulatory death increased to 14.0% in 2023. Candidates listed at adult statuses 1 and 2 underwent transplant more quickly (2,225.8 and 1,088.1 transplants per 100 patient-years, respectively). In 2023, adult waitlist mortality reached a low: 8.5 deaths per 100 patient-years. Multiorgan transplants (heart-liver and heart-kidney) in adults continue to increase, achieving comparable survival to that of heart transplant alone. Adults with congenital heart disease had the lowest pretransplant mortality of all diagnoses but also the lowest posttransplant survival, 76.1% at 5 years, emphasizing the need for consensus on best practices. In pediatric heart transplant, heart transplants increased 36.3% and new listings increased 34.0%, but the transplant rate decreased 14.9% resulting in increased waiting times. High-urgency listings increased, with 83.6% of heart transplants performed for status 1A. Pediatric waitlist mortality has declined 53.4% since 2012, but remains substantial: 11.7 deaths per 100 patient-years. In 2023, 5-year posttransplant survival was 80.3% in adult recipients and 84.4% in pediatric recipients. Keywords: Allocation, donor, heart failure, heart transplant, left ventricular assist device, mechanical circulatory support, outcomes

1 Introduction

Heart transplant affords eligible patients with end-stage heart disease the best opportunity for long-term survival. Yet, pretransplant risk stratification, the growing use of temporary mechanical circulatory support (MCS), disparities in access and outcomes, access management, growing medical complexity in the face of regulatory oversight, and rising costs of transplant remain challenges for the transplantation community. Fontan failure is one of the most common indications for heart transplant in adults with congenital heart disease and presents a unique challenge for heart transplant programs. Due to improvements in management and, subsequently, survival, the number of patients with Fontan circulation is growing; however, it is anticipated that one-third of these patients will either die or require heart transplant within 35 years of Fontan surgery.¹^,² Heart transplant programs plagued with constantly balancing candidate risk with programmatic oversight are universally challenged by treating these patients, raising the question of whether, similar to multiorgan transplant, consideration could be given to excluding Fontan patients from performance metrics. Risk stratification of heart transplant candidates remains suboptimal for both adult and pediatric settings. The pediatric heart transplant allocation system remains 3-tiered, and as seen under the prior adult policy, waiting times and waitlist mortality are increasing and more patients are being added to higher acuity status. The continuous distribution allocation policy is in development and is anticipated to allow more fluidity in prioritization and enhanced risk stratification. Multiorgan transplant continues to increase, and in September 2023, a policy to establish eligibility criteria and safety net for heart-kidney allocation and for heart-liver allocation was approved by the Organ Procurement and Transplantation Network (OPTN); however, it is too early to assess the impact of this policy.

The Annual Data Report provides an overview of the state of heart transplantation in the United States, including positive trends and trends that warrant further investigation and monitoring. Data on US adult and pediatric heart transplant waiting lists, donation, transplants, and outcomes are provided. Of note, the Impella 5.5 device was added to the OPTN computer system in August 2023. Thus, in the current report, Impella 5.5 is captured as “Other” or in some cases in the left ventricular assist device (LVAD) category. It is anticipated that future iterations of the Annual Data Report will be able to provide more granularity regarding temporary MCS.

2 Adult Heart Transplant

2.1 Waitlist Trends

There has been increasing turnover on the adult heart transplant waiting list. Since 2021, the number of patients awaiting heart transplant at the beginning and end of the year has declined, despite more additions to the list than ever; this is primarily due to transplants, because removals for death or “Other” reasons have declined while removals for improvement, being too ill, or patient declining have remained stable (Table HR 5 and Table HR 6). The number of candidates being added to the waiting list each year has gradually increased over the past decade, by 60.6% since 2012 (Figure HR 1). In 2020, there was a decrease in new additions to the waiting list, most likely due to the pandemic; however, since then, the number of new additions has increased by 1,064 (26.6%). Between 2013 and 2023, the number of candidates awaiting transplant on December 31 of a given year has decreased 15.2%. There have been no significant shifts in distribution by candidate age group or sex, but the prevalences of cardiomyopathy, congenital heart disease, and ventricular assist device (VAD) use have increased (Table HR 1 and Table HR 2). In addition, the proportion of non-White candidates on the waiting list has increased since 2012, with the greatest increase, 92.9%, occurring in the Native American category—although only 0.54% of candidates in 2023 were Native American (Figure HR 5). In 2023 and 2012, the proportions of White candidates were 56.2% and 68.0% and the proportions of Black candidates were 27.8% and 21.2%, respectively. Among candidates who had been awaiting transplant at any time in the given year, the proportion with waiting time of less than 90 days has increased since 2012, with the steepest increase occurring since 2018. In 2023, 50.5% of candidates had been on the list less than 90 days compared with 30.7% in 2012 and 32.2% in 2018 (increases of 64.5% and 56.8%, respectively). As a result, the proportion of candidates who had been listed for longer periods decreased. In 2023, there were fewer candidates on the list for 2 years or more: 16.5% in 2023 versus 20.7% in 2012 (Figure HR 7).

Duration on the waiting list takes into account candidates who underwent transplant, died, were removed for other reasons, or were still waiting. The shift to more candidates on the list for a shorter duration may be partially explained by the increase in transplant rates among high-urgency candidates and also by the increase in the number of additions to the list (Figure HR 7).

The behavioral changes that accompanied the 2018 policy revision are having a greater impact, with increasing listings at adult status 2. From 2019 through 2021, approximately one-third of candidates were listed at adult status 4. However, from 2021 through 2023, adult status 2 candidates (typically candidates with temporary MCS) increased while adult status 4 candidates declined, as centers began to favor temporary MCS over durable MCS to improve access to transplant; in 2023, adult status 2 candidates constituted 30.7% (Figure HR 9). During 2019-2023, the proportion of adult status 1 candidates, those typically on extracorporeal membrane oxygenation (ECMO), increased: 7.8% in 2023 versus 4.2% in 2019. The proportion of adult status 3 candidates declined: 7.6% in 2023 versus 11.7% in 2019. The increase in ECMO, intra-aortic balloon pump, and Impella use after the policy revision has been well described,³ and while there was a surge in the number of patients who had ECMO at transplant following the policy change, the increased use of intra-aortic balloon pump and Impella resulted in more adult status 2 candidates⁴^,⁵ (Figure HR 9). Candidates listed at high-urgency status, adult statuses 1-3, accounted for 46.2% of all listings in 2023, a 28.0% increase since 2019. Trends by donor service area demonstrated that in 2023, most donation service areas listed approximately 7%-8% of candidates at adult status 1 and approximately 30% at adult status 2 (Table HR 4). Notable outliers included the following: region 8 listed 4.8% and 41.7% at adult statuses 1 and 2, respectively; region 11 listed 10.4% at adult status 1; and region 10 listed 22.1% at adult status 2.

2.2 Heart Transplant Rates

Since 2012, the overall heart transplant rate for adults increased 106.1%: 140.8 transplants per 100 patient-years in 2023 compared with 68.3 transplants per 100 patient-years in 2012. The heart transplant rate has increased 57.3% since 2019, the first year after the allocation policy revision in 2018 (Figure HR 13). All age groups had increases in transplant rates, although transplant rate tends to be highest in candidates aged 65 years or older; for those in this age group, it was 162.0 transplants per 100 patient-years in 2023 (Figure HR 14). There were similar increases in transplant rate for candidates of all races and ethnicities and diagnoses. The rate of transplant in Asian candidates far exceeded that in all of the other racial and ethnic categories: 216.9 transplants per 100 patient-years, with the Other category being second highest at 177.8 transplants per 100 patient-years. Despite increasing 97.7% since 2012, the transplant rate in Black candidates has tended to be the lowest of the racial and ethnic categories and remained so: 122.2 transplants per 100 patient-years in 2023 (Figure HR 15).

Among the diagnoses in adult candidates, the greatest change in transplant rate occurred in those with valvular heart disease: 175.5 transplants per 100 patient-years in 2023 compared with 48.9 transplants per 100 patient-years in 2012, a 258.9% increase. Candidates with congenital heart disease had a steep increase in transplant rate, particularly following the policy change, to 99.3 transplants per 100 patient-years in 2023. Yet, candidates with congenital heart disease have not had transplant rates comparable to those of the other diagnoses, and this was the lowest transplant rate of all diagnoses in 2023. The second-lowest transplant rate in 2023 occurred in candidates with coronary artery disease: 133.9 transplants per 100 patient-years (Figure HR 16). As expected, the transplant rates among adult statuses 1 and 2 were higher (2,225.8 and 1,088.1 transplants per 100 patient-years, respectively) than those of other statuses. Since 2019, there was an increase in transplant rate for all statuses except adult status 2, which declined by 7.0% (Figure HR 20).

Among adult patients listed in 2020, 74.0% underwent transplant by 3 years, a 9.0% increase since 2012 (Figure HR 24). Among those newly listed in 2020, by 3 years, 4.3% had died, 15.7% were removed for other causes, and 6.0% were still waiting (Figure HR 23). Since 2012, more patients have undergone transplant earlier after listing. The proportion of patients undergoing transplant within 3 months and within 1 year has steadily increased. Among patients listed in 2022, 58.3% underwent transplant within 3 months and 71.4% within 1 year, compared with 31.7% and 53.1%, respectively, in 2012 (Figure HR 24). In 2023, the lowest transplant rates occurred among candidates listed at adult statuses 4-6, inactive candidates, candidates with congenital heart disease, adults listed under pediatric status, and candidates with blood type O—all of which had transplant rates of less than 100 transplants per 100 patient-years (Figure HR 16, Figure HR 17, and Figure HR 20).

2.3 Pretransplant Mortality

In general, pretransplant mortality in adults waitlisted for heart transplant has decreased substantially since 2012. Overall pretransplant mortality reached a low of 8.5 deaths per 100 patient-years in 2023 despite a slight increase in 2020 (Figure HR 25). The pretransplant mortality rate declined for all racial and ethnic categories, although in 2023 it remained slightly higher for Asian and Hispanic candidates (10.5 deaths per 100 patient-years and 10.8 deaths per 100 patient-years, respectively) and was lowest for Black candidates (7.9 deaths per 100 patient-years). There have been fluctuations in mortality rates among all the racial and ethnic categories, but there were two outliers over the past decade: in 2015, the pretransplant mortality for Asian candidates was 20.1 deaths per 100 patient-years, and in 2017, it was 40.9 deaths per 100 patient-years for candidates classified as Other race and ethnicity (Figure HR 27). Among the diagnosis categories, pretransplant mortality was lowest among adult candidates with congenital heart disease in 2023 at 3.1 deaths per 100 patient-years, a remarkable decline from 17.1 deaths per 100 patient-years in 2012 (Figure HR 29), possibly due to the increasing consensus regarding a multidisciplinary approach to management and earlier referral to adult teams for heart failure.⁶^,⁷^,⁸

Compared with 2019, pretransplant mortality rates decreased for candidates in all active status groups except adult status 1, in which pretransplant mortality increased from 114.7 deaths per 100 patient-years in 2019 to 129.1 deaths per 100 patient-years in 2023, following a peak of 149.1 deaths per 100 patient-years in 2022. In 2023, candidates listed at adult status 6 continued to have the lowest pretransplant mortality rate: 3.0 deaths per 100 patient-years. Candidates listed at adult status 4 had the second-lowest pretransplant mortality: 5.3 deaths per 100 patient-years (Figure HR 32). The intent of the 2018 heart allocation policy revision was partially to improve risk stratification based on pretransplant mortality; however, pretransplant mortality of adult status 5 candidates exceeds that of adult status 4 candidates, and in some years, including 2023, that of adult status 3 candidates. Candidates listed at adult status 5 are those requiring multiorgan transplant. Although most multiorgan candidates are listed for heart-kidney, there are growing numbers of heart-liver and heart-lung candidates as well as candidates for triple-organ transplant; this has created heterogeneity in the complexity, which may exceed that of some patients with an LVAD, some patients with congenital heart disease, and some patients with restrictive cardiomyopathy, hypertrophic cardiomyopathy, and amyloid cardiomyopathy (adult status 4), and which may be on par with candidates listed for LVAD complications (adult status 3) (Figure HR 32). Pretransplant mortality ranged from 0 to 42.16 deaths per 100 patient-years between donation service areas (Figure HR 33), and the median was 8.1 deaths per 100 patient-years.

The pandemic resulted in increased mortality among patients with illnesses other than COVID-19.⁹ Some transplant centers restricted heart transplants to the most urgent patients during the pandemic. Despite this, there was only a slight increase in the overall pretransplant mortality rate, from 8.7 deaths per 100 patient-years in 2019 to 9.0 deaths per 100 patient-years in 2020. More pronounced increases were seen in Asian, Black, and Hispanic candidates (Figure HR 27), in candidates residing in nonmetropolitan areas (Figure HR 30), and in candidates listed at adult statuses 1, 3, and 6 (Figure HR 32). Of note, pretransplant mortality for candidates listed as adult status 1 increased from 114.7 to 136.2 deaths per 100 patient-years between 2019 and 2020. In 2021, the year after the declaration of the national emergency for the pandemic, there was a steep decline in pretransplant mortality for adult status 1 candidates to 81.2 deaths per 100 patient-years, a change not seen in the other status groups and which cannot be explained by changes in transplant rate alone (Figure HR 32). In inactive candidates, pretransplant mortality was lower in 2020 (10.8 deaths per 100 patient-years) compared with 2019 (12.2 deaths per 100 patient-years).

Adult deaths within 6 months of removal from the transplant waiting list reached a nadir in 2021, and in 2023 the rate was 13.0 deaths per 100 patient-years, representing a 57.8% decrease from 2012 (Figure HR 34). In 2023, death within 6 months of removal occurred least in age group 18-34 years and most in age group 65 years or older: 3.7 deaths per 100 patient-years and 15.8 deaths per 100 patient-years, respectively. Although there was a decline in death after removal in all age groups, it was most notable in age group 18-34 years, decreasing 86.5% since 2012 (Figure HR 35). Asian candidates had deaths within 6 months of removal in excess of other racial and ethnic categories in 2023, at 26.1 deaths per 100 patient-years (Figure HR 36). There have been fluctuations in the occurrences of death within 6 months of removal for all status categories, but in 2023, the occurrence of death after removal remained high for candidates listed at adult statuses 1 and 2, at 27.8 deaths per 100 patient-years and 25.8 deaths per 100 patient-years, respectively. This is not surprising given the relative acuity of these patients.

2.4 Heart Transplant Trends

In 2023, there were 4,092 adult heart transplants performed. Adult heart transplant volume continues to increase, and in 2023, the largest annual increase of the past decade occurred. From 2022 to 2023, there were an additional 424 adult heart transplants performed in the United States. A similar increase, 405, was seen between 2015 and 2016 (Figure HR 39). The third-greatest increase, 295 transplants, occurred from 2021 to 2022. From 2012 to 2023, heart transplants increased by an average of 187 each year (median change, 126). Although transplant volume growth may be partially explained by more candidates being listed at a higher status, an increase in donors (Figure HR 63) and the promise of donation after circulatory death (DCD) may also be responsible. It has been projected that widespread use of DCD heart transplant could increase the donor pool by 30%.¹⁰ Between 2020 and 2023, the percentage of DCD hearts recovered for transplant surged from 3.4% to 14.0% (Figure HR 69), which seems to indicate a substantial increase in heart transplants performed using DCD hearts, but some of these may have been unused. In 2017 and 2018, there were no DCD heart transplants performed, as no DCD hearts were recovered for transplant.

Transplants performed in age groups 65 years or older and 18-34 years increased 132.8% and 115.8%, respectively, from 2012 to 2023 (Figure HR 40). There have been notable increases in transplants in all racial and ethnic categories, although transplants in the Multiracial, Native American, and unreported groups remained relatively low. In 2023, there were 32 transplants performed in Native American patients, 17 in Multiracial patients, and 12 in patients in the unreported category (Figure HR 42). Racial and ethnic disparities in the use of advanced heart failure therapies have been well described.¹¹^,¹² Trends in transplant volume are promising. In 2023, there were 1,046 (25.6%) transplants performed in Black patients, a 161.5% increase from 400 transplants in 2012. Similar increases were seen in Hispanic and Asian recipients (Figure HR 42).

Despite growing numbers of transplants for all diagnoses in adults since 2012, the number of transplants performed for valvular heart disease has changed little since 2014; in 2023, only 38 transplants were performed for valvular heart disease (Figure HR 43). Since 2019, transplants have increased for all urgency status categories except adult status 3. In 2023, most transplants, 2,224 (54.3%), were performed in adult status 2 candidates (Figure HR 44). In general, patients with an LVAD and congenital heart disease are listed as adult status 4, and there has been increasing concern regarding excessive waiting times for adult status 4 candidates. The number of transplants for candidates listed at adult status 4 peaked at 737 in 2020 but has declined since then; in 2023, 580 (14.2%) transplants were performed in adult status 4. In 2023, the fewest transplants, 62, were performed in patients listed at adult status 5. Only 1.5% of candidates were listed at adult status 5 in 2023, which may be a result of centers listing candidates who require dual-organ transplant at higher statuses.

In 2023, multiorgan transplants constituted 13.5% of heart transplants in adults compared with 6.0% in 2012 (Figure HR 45). Heart-kidney transplants increased the most during this period: 421 transplants in 2023 versus 76 in 2012. Heart-lung transplants continued to increase, but they were less than 2% of all heart transplants and were 9.6% of all multiorgan transplants in 2023; only 53 adult heart-lung transplants were performed in the United States in 2023. The number of heart-liver transplants has surpassed heart-lung transplants; 70 adult heart-liver transplants were performed in 2023.

In 2023, the typical adult heart transplant recipient was male, aged 50-64 years, White (but more likely to be non-White than a decade ago), blood type O, without a VAD, calculated panel-reactive antibody (cPRA) < 1%, and adult status 2 at transplant. The typical recipient in 2023 had private insurance, resided in a metropolitan area, and was within 50 miles of the transplant center. While 45.9% of recipients had private insurance, 34.9% had Medicare and 14.7% had Medicaid (Table HR 8 and Table HR 9).

The use of induction therapy has fluctuated but tends to be more common than no induction over the past decade, with interleukin-2 agents most used (Figure HR 46 and Figure HR 47). Triple therapy with tacrolimus, a mycophenolate agent, and steroid was the most common immunosuppression regimen reported prior to discharge (Figure HR 48).

2.5 Posttransplant Survival and Morbidity

Trends in adult posttransplant mortality have been favorable. Although transplant mortality has fluctuated, since 2012, there has been an overall decline in posttransplant mortality at 6 months and at 1, 3, and 5 years (Figure HR 49). Six-month and 1- and 3-year mortality were lowest for patients who underwent transplant in 2018. There was a transient increase in posttransplant mortality for patients who underwent transplant in 2019, which exceeded that of the year prior to the new policy; however, for patients who underwent transplant in 2022, 6-month and 1-year posttransplant mortality were slightly lower (7.0% and 8.4%, respectively) than prepandemic and lower than the year prior to the policy revision. Three-year mortality among patients who underwent transplant in 2020 was 16.0%.

Among adult patients who underwent transplant in 2016-2018, the 5-year survival was 80.3%. Overall 1-year and 3-year patient survival were 91.5% and 85.9%, respectively (Figure HR 50). Older patients tended to have early decrements in survival compared with recipients aged 18-49 years; patients 65 years or older had the greatest decline in survival during the first year to 89.3%, while survival in the other age groups declined by less than 10% and remained greater than 90% at year 1. By 5 years, survival in patients 65 years or older was 77.3% compared with greater than 80% in other age groups (Figure HR 51). Patient survival was best in those aged 18-34 years through year 1, after which it was similar to that in age groups 35-49 and 50-64 years. Relatively early decline in patient survival was noted in Hispanic recipients compared with other racial and ethnic categories between 2-3 months posttransplant and declined to 91.7% at 6 months. By year 1, survival was slightly lower in Hispanic recipients, 90.3%, and highest in Black recipients, 92.4%. During year 2, Black and Asian patients had a similar decline (Figure HR 52). At year 5, survival was lowest in Black and Hispanic recipients, 77.2% and 77.3%, and highest in White recipients, 81.7%.

Adults with prior congenital heart disease who received a heart in 2016-2018 tended to have the lowest survival at all time points compared to recipients with other diagnoses, with a decrease in survival of greater than 10% within the first 3 months. At 1 year, survival in recipients with prior congenital heart disease was 86.0%, while survival ranged from 89.9% to 92.6% in the other diagnosis categories. This trajectory in survival persisted for congenital heart disease, with survival declining to 76.1% at 5 years. Patients with prior coronary artery disease had the second-lowest survival at 5 years, 77.2%. Survival at 5 years was greater than 80% for cardiomyopathy, valvular, and Other/unknown (Figure HR 53). Recipients who had a VAD tended to have slightly lower patient survival compared with recipients without a VAD: at 5 years, 79.3% and 81.2%, respectively (Figure HR 55).

Posttransplant patient survival by status (2018 heart revision categories) was analyzed for patients who received a heart in 2020-2021. Posttransplant survival tended to be similar between recipients who were adult statuses 2-4 and 6; however, there was an early and pronounced decrement in survival in recipients who were adult status 5 (Figure HR 57). Survival in recipients who were adult status 5 decreased within the first month of transplant; although initially at 100%, survival had declined to 87.5% by 3 months. Adult status 5 transplants were a small proportion, at only 80 transplants performed during this period (Figure HR 44). A similar, but less pronounced, trend was noted in recipients who were adult status 1, with a decline in survival seen within the first 3 months of transplant. At 1 year, survival was 83.8% in adult status 5, 87.1% in adult status 1, and greater than 90% in the other groups. Two-year survival was only 75.0% in adult status 5 recipients, 84.3% in adult status 1, and 86% or greater in the other status groups. Adult status 2 and adult status 6 recipients tended to have the best survival. Although higher posttransplant mortality may not be unexpected in adult status 1 recipients due to their acuity prior to transplant, the reason for higher mortality in adult status 5 recipients is not immediately obvious; however, it may be explained by multiorgan failure and longer waiting time for transplant. Adult status 5 recipients tend to have higher waitlist mortality, which may be an indication of medical acuity.

Heart-kidney and heart-liver transplant recipients who underwent transplant in 2016-2018 tended to have similar outcomes over 5 years, with heart-liver having the best patient survival at 5 years: 82.1%. In addition, patient survival for heart-kidney and heart-liver recipients was similar to that for heart-alone recipients in this cohort. Recipients in the “Other multiorgan” category, of which there were only 9, had the worst early survival, declining to 66.7% during the first year and remaining at 66.7% at 5 years; however, survival in heart-lung transplant recipients remained the lowest of all multiorgan categories, at 86.6% at 1 year and 64.2% at 5 years (Figure HR 59). Patients with cPRA of 98%-100% who received a heart in 2016-2018 had worse survival compared with other cPRA groups (Figure HR 60).

3 Donation

Deceased heart donors reached a peak in 2023 at 4,664 (adult and pediatric), a 90.3% increase since 2012 (Figure HR 63). There was a notable increase in donors aged 30-39 years (1,525 in 2023 compared with 456 in 2012); this group now constitutes the majority of donors, surpassing those aged 18-29 years (Figure HR 64 and Figure HR 65). Many programs have developed DCD programs and accept hearts from donors who are hepatitis C virus (HCV) positive to broaden access to transplant. Since 2016, the proportion of donors who were HCV positive, by antibody and nucleic acid test as NAT+ or NAT-/Ab+, has increased: for NAT+, 5.0% in 2023 versus 0.4% in 2016; for NAT-/Ab+, 4.9% in 2023 versus 0.2% in 2016 (Figure HR 68). Since 2019, there has been a steady and persistent increase in DCD: 14.0% of hearts donors in 2023 compared with 0.22% in 2019 (Figure HR 69). The proportion of hearts recovered for transplant and not transplanted (nonuse) reached a nadir of 0.7% in 2018, from 1.2% in 2012. There has been a subsequent increase in heart nonuse to 1.5% in 2023 (Figure HR 71). Nonuse rates have fluctuated in several categories, but notable trends include a 57.4% decrease in unused organs in the donor age group of 55 years or older: 1.6% in 2023 compared with 3.8% in 2012 (Figure HR 72). Nonuse amongst donors with hypertension decreased to 1.2% in 2023 while nonuse increased in donors without hypertension (Figure HR 75). Nonuse rates tend to be high in donors with body mass index (BMI) of 40 or higher; nonuse of hearts from these donors was 3.3% in 2023 (Figure HR 76). Nonuse of hearts from donors with head trauma increased to 1.6% in 2023 (Figure HR 77).

4 Pediatric Heart Transplant

4.1 Waitlist Trends

In 2023, the number of new pediatric candidates added to the waiting list reached its highest point at 737, up 34.0% from 2012 (Figure HR 79). There were a total of 1,248 prevalent candidates aged 17 years or younger, which represents a 44.6% increase from 2012 (Figure HR 80). The largest pediatric age groups on the waiting list in 2023 were 1-5 years (26.1%) and 12-17 years (25.6%), followed by 6-11 years (21.2%) and younger than 1 year (21.1%) (Figure HR 81). Half of pediatric heart transplant candidates were White (50.2%), 21.6% were Hispanic, 19.6% were Black, 3.4% were Asian, 0.6% were Native American, and 0.8% had unreported race and ethnicity (Figure HR 82). Congenital defects continued to be the leading and increasingly common diagnosis among pediatric heart transplant candidates, at 61.5% in 2023, which is a 35.2% increase since 2012 (Figure HR 83). Just over half (52.0%) of pediatric heart transplant candidates lived less than 50 miles from the transplant center (Table HR 11). The proportion of candidates listed with a VAD increased to 13.6% in 2023, from 5.1% in 2013 (Table HR 12). Among the 733 pediatric candidates for heart transplant removed from the waiting list in 2023 (Table HR 14), 531 (72.4%) were removed due to undergoing transplant, 62 (8.5%) died, 59 (8.0%) were removed due to improved condition, and 28 (3.8%) were considered too sick to undergo transplant (Table HR 15).

The proportion of pediatric heart transplant candidates on the waiting list less than 90 days continued its general decline over the past decade: 34.4% in 2023 compared with 46.9% in 2012, which represents a 26.7% decrease. The proportion of candidates waiting 3-<6 months had a 46.1% increase: 20.6% in 2023 versus 14.1% in 2012 (Figure HR 85). Half (50.7%) of pediatric candidates were listed at status 1A in 2023, followed by 18.4% at status 1B and 9.5% status 2 (Figure HR 86). Just over 70% of pediatric candidates newly listed in 2018-2020 underwent transplant within 3 years, 14.7% were removed from the list, 9.1% died, and 4.7% were still waiting (Figure HR 87).

In 2023, the heart transplant rate among pediatric candidates decreased to its lowest rate in the past decade, 99.7 transplants per 100 patient-years, which is a 14.9% decrease from 117.1 transplants per 100 patient-years in 2012 (Figure HR 88). Transplant rates in 2023 varied by age, with the highest rates for candidates aged 12-17 years (183.5 transplants per 100 patient-years) and younger than 1 year (129.5 transplants per 100 patient-years), followed by 6-11 years (66.3 transplants per 100 patient-years) and 1-5 years (62.8 transplants per 100 patient-years). Since 2012, transplant rates in candidates younger than 1 year decreased by 50.2%; in those aged 1-5 years, decreased by 32.6%; in those aged 6-11 years, decreased by 26.6%; and in those aged 12-17 years, increased by 42.1% (Figure HR 89). Transplant rates in 2023 were similar across racial and ethnic categories among pediatric waitlist candidates (Figure HR 90).

Overall pretransplant mortality in pediatric candidates waitlisted for heart transplant was 11.7 deaths per 100 patient-years in 2023, which is a 53.4% decline from 25.1 deaths per 100 patient-years in 2012 (Figure HR 92). Pretransplant mortality rates varied by age, with the highest 2023 rate in candidates younger than 1 year, at 29.5 deaths per 100 patient-years, followed by those aged 1-5 years, 6-11 years, and 12-17 years at 11.1, 5.8, and 5.8 deaths per 100 patient-years, respectively (Figure HR 93). By race and ethnicity, 2023 pretransplant mortality rates among Asian, Hispanic, Black, and White candidates were 21.8, 13.7, 12.3, and 10.1 deaths per 100 patient-years, respectively (Figure HR 94). By diagnosis, pretransplant mortality in 2023 was highest among those with congenital defects at 13.4 deaths per 100 patient-years (Figure HR 95). By medical urgency, pretransplant mortality in 2023 was highest for candidates listed at status 1A (25.7 deaths per 100 patient-years), followed by status 1B (7.7 deaths per 100 patient-years) and status 2 (2.3 deaths per 100 patient-years) among active statuses (Figure HR 96).

4.2 Trends in Heart Transplant

The number of pediatric heart transplants performed increased to 507 in 2023, a 36.3% increase from 2012 (Figure HR 98). There were 202 (39.8%) heart transplants performed in recipients aged 12-17 years, 118 (23.3%) in recipients younger than 1 year, 94 (18.5%) in recipients aged 6-11 years, and 91 (17.9%) in recipients aged 1-5 years (Figure HR 99). The 202 transplants in recipients aged 12-17 years is a 96.1% increase from 2012. Over the past decade, the proportion of transplant recipients aged 12-17 years has also increased, to 39.8% in 2023 compared with 33.3% in 2013, whereas the proportion aged younger than 1 year decreased, to 23.3% in 2023 compared with 28.5% in 2013 (Table HR 17). Looking at 2023 pediatric heart transplant counts by race and ethnicity, there were 268 transplants in White recipients, 99 in Hispanic recipients, 98 in Black recipients, 19 in Asian recipients, 18 in Multiracial recipients, and 4 in Native American recipients (Figure HR 101). Congenital defects as the primary cause of disease increased over the past decade: 56.8% of pediatric heart transplant recipients in 2023 compared with 43.1% in 2013 (Table HR 18). The proportion who underwent transplant at status 1A declined (83.6% in 2023 versus 92.0% in 2013), whereas the proportion who underwent transplant at status 1B increased (14.2% in 2023 versus 5.8% in 2013) and the proportion at status 2 stayed stable (Table HR 18). There has been a shift in the waiting time over the past decade, with fewer recipients who underwent transplant with 1-<90 days waiting time and more with 3-<6 months and 6-<12 months of waiting time (Table HR 19). The proportion of pediatric heart transplant recipients with a VAD at transplant has increased: 42.0% in 2023 versus 26.5% in 2013 (Table HR 18). The proportion of ABO-incompatible transplants has also increased: 7.5% in 2023 versus 4.1% in 2013 (Table HR 19).

With some shifts over the years, induction therapy use has increased since 2012, to 86.6% of pediatric heart transplant recipients in 2023 (Figure HR 104); 77.0% reported T-cell–depleting therapy alone, 8.5% interleukin-2 receptor antibody only, 1.2% both, and 13.4% no induction agents (Figure HR 105). In 2023, the initial immunosuppression regimen used in pediatric heart transplant recipients was tacrolimus and a mycophenolate agent (44.8%), followed by tacrolimus, mycophenolate, and steroids (42.2%), and other combinations (11.0%) (Figure HR 106).

4.3 Posttransplant Survival and Morbidity

Among pediatric heart transplant recipients in 2022, the incidence of acute rejection in the first year posttransplant was 18.8% in recipients aged 12-17 years, 15.4% in those aged 6-11 years, 14.4% in those aged 1-5 years, and 8.8% in those younger than 1 year (Figure HR 107). Among pediatric heart transplant recipients in 2012-2018, the overall incidence of posttransplant lymphoproliferative disorder was 5.4% at 5 years; the incidence was 6.9% among recipients who were Epstein-Barr virus negative and 3.9% among recipients who were Epstein-Barr virus positive (Figure HR 108).

Recipient death occurred in 6.9% of patients at 6-months posttransplant and in 8.3% at 1-year posttransplant among pediatric heart transplants performed in 2022, in 11.6% at 3 years for transplants performed in 2020, in 17.1% at 5 years for transplants performed in 2018, and in 25.8% at 10 years for transplants performed in 2013 (Figure HR 109). Overall, 1-, 3-, and 5-year patient survival rates were 93.3%, 88.2%, and 84.4%, respectively, among recipients who underwent transplant in 2016-2018 (Figure HR 110). By age, 5-year patient survival was 82.8% for recipients younger than 1 year, 82.6% for those aged 1-5 years, 88.1% for those aged 6-11 years, and 85.0% for those aged 12-17 years among recipients who underwent transplant in 2016-2018 (Figure HR 111). By race and ethnicity, 5-year patient survival ranged from 86.7% among Asian recipients to 86.3% among White recipients, 82.5% among Hispanic recipients, and 81.5% among Black recipients (Figure HR 112). By etiology of disease, 5-year patient survival was lowest among children with congenital defects at 80.2% and highest for children with myocarditis at 93.5% (Figure HR 113). By urgency status, the 5-year patient survival for pediatric recipients was 83.5% for status 1A, 88.5% for status 1B, and 82.9% for status 2 (Figure HR 114).

References

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Poh CL, Cordina RL, Iyengar AJ, Zannino D, Grigg LE, Wheaton GR, Bullock A, Ayer J, Alphonso N, Gentles TL. Pre-and post-operative determinants of transplantation-free survival after Fontan. The Australia and New Zealand experience. Int J Cardiol Heart Vasc. 2021;35:100825. doi:10.1016/j.ijcha.2021.100825

Parker WF, Chung K, Anderson AS, Siegler M, Huang ES, Churpek MM. Practice changes at US transplant centers after the new adult heart allocation policy. J Am Coll Cardiol. 2020;75:2906-2916. doi:10.1016/j.jacc.2020.01.066

Varshney AS, Berg DD, Katz JN, Baird-Zars VM, Bohula EA, Carnicelli AP, Chaudhry S-P, Guo J, Lawler PR, Nativi-Nicolau J. Use of temporary mechanical circulatory support for management of cardiogenic shock before and after the United Network for Organ Sharing donor heart allocation system changes. JAMA Cardiol. 2020;5:703-708. doi:10.1001/jamacardio.2020.0692

Golbus JR, Gupta K, Colvin M, Cascino TM, Aaronson KD, Kumbhani DJ, Saran R, Nallamothu BK. Changes in type of temporary mechanical support device use under the new heart allocation policy. Circulation. 2020;142:1602-1604. doi:10.1161/CIRCULATIONAHA.120.048844

Van De Bruaene A, Droogne W, Van Cleemput J, Rega F, Budts W. When to refer adult patients with congenital heart disease for transplantation: which criteria to use, which work-up? Int J Cardiol Congenit Heart Dis. 2021;4:100150. doi:10.1016/j.ijcchd.2021.100150

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Support, Copyright, and Citation Information

This publication was produced for the U.S. Department of Health and Human Services (HHS), Health Resources and Services Administration (HRSA), by Hennepin Healthcare Research Institute (HHRI) and the United Network for Organ Sharing (UNOS) under contracts HHSH75R60220C00011 and HHSH250201900001C, respectively. Dr. Israni was supported in part by AHRQ R01HS028829.

This publication lists nonfederal resources in order to provide additional information to consumers. The views and content in these resources have not been formally approved by HHS or HRSA. Neither HHS nor HRSA endorses the products or services of the listed resources.

The OPTN/SRTR 2023 Annual Data Report is not copyrighted. Readers are free to duplicate and use all or part of the information contained in this publication. Data are not copyrighted and may be used without permission if appropriate citation information is provided.

Pursuant to 42 U.S.C. 1320b-10, this publication may not be reproduced, reprinted, or redistributed for a fee without specific written authorization from HHS.

Suggested Citations:

Full citation: Organ Procurement and Transplantation Network (OPTN) and Scientific Registry of Transplant Recipients (SRTR). OPTN/SRTR 2023 Annual Data Report. U.S. Department of Health and Human Services, Health Resources and Services Administration; 2025. Accessed [insert date]. https://srtr.transplant.hrsa.gov/annualdatareports
Abbreviated full citation: OPTN/SRTR 2023 Annual Data Report. HHS/HRSA; 2025. Accessed [insert date]. https://srtr.transplant.hrsa.gov/annualdatareports
Chapter citation: [Authors]. OPTN/SRTR 2023 Annual Data Report: [chapter]. Accessed [insert date]. https://srtr.transplant.hrsa.gov/annualdatareports
Chapter citation for AJT e-supplement available at amjtransplant.org: [Authors]. OPTN/SRTR 2023 Annual Data Report: [chapter]. Am J Transplant. 2025;25([issue and suppl numbers]):[page range]. [doi]

Publications based on data in this report or supplied on request must include a citation and the following statement: The data and analyses reported in the OPTN/SRTR 2023 Annual Data Report have been supplied by the United Network for Organ Sharing and Hennepin Healthcare Research Institute under contract with HHS/HRSA. The authors alone are responsible for reporting and interpreting these data; the views expressed herein are those of the authors and not necessarily those of the U.S. government.

This report is available at https://srtr.transplant.hrsa.gov/annualdatareports. Individual chapters may be downloaded.

List of Figures

Figure HR 1: New adult candidates added to the heart transplant waiting list
Figure HR 2: All adult candidates on the heart transplant waiting list
Figure HR 3: Distribution of adults waiting for heart transplant by age
Figure HR 4: Distribution of adults waiting for heart transplant by sex
Figure HR 5: Distribution of adults waiting for heart transplant by race and ethnicity
Figure HR 6: Distribution of adults waiting for heart transplant by diagnosis
Figure HR 7: Distribution of adults waiting for heart transplant by waiting time
Figure HR 8: Distribution of adults waiting for heart transplant by former medical urgency groups through October 17, 2018
Figure HR 9: Distribution of adults waiting for heart transplant by new medical urgency groups, October 18, 2018, through 2023
Figure HR 10: Distribution of adults waiting for heart transplant by BMI
Figure HR 11: Distribution of adults waiting for heart transplant by blood type
Figure HR 12: Distribution of adults waiting for heart transplant by prior transplant status
Figure HR 13: Overall deceased donor heart transplant rates among adult waitlist candidates
Figure HR 14: Deceased donor heart transplant rates among adult waitlist candidates by age
Figure HR 15: Deceased donor heart transplant rates among adult waitlist candidates by race and ethnicity
Figure HR 16: Deceased donor heart transplant rates among adult waitlist candidates by diagnosis
Figure HR 17: Deceased donor heart transplant rates among adult waitlist candidates by blood type
Figure HR 18: Deceased donor heart transplant rates among adult waitlist candidates by sex
Figure HR 19: Deceased donor heart transplant rates among adult waitlist candidates by former medical urgency groups through October 17, 2018
Figure HR 20: Deceased donor heart transplant rates among adult waitlist candidates by new medical urgency groups, October 18, 2018, through 2023
Figure HR 21: Deceased donor heart transplant rates among adult waitlist candidates by height
Figure HR 22: Deceased donor heart transplant rates among adult waitlist candidates by metropolitan versus nonmetropolitan residence
Figure HR 23: Three-year outcomes for adults waiting for heart transplant, new listings in 2020
Figure HR 24: Percentage of adults who underwent deceased donor heart transplant within a given period of listing
Figure HR 25: Overall pretransplant mortality rates among adults waitlisted for heart transplant
Figure HR 26: Pretransplant mortality rates among adults waitlisted for heart transplant by age
Figure HR 27: Pretransplant mortality rates among adults waitlisted for heart transplant by race and ethnicity
Figure HR 28: Pretransplant mortality rates among adults waitlisted for heart transplant by sex
Figure HR 29: Pretransplant mortality rates among adults waitlisted for heart transplant by diagnosis
Figure HR 30: Pretransplant mortality rates among adults waitlisted for heart transplant by metropolitan versus nonmetropolitan residence
Figure HR 31: Pretransplant mortality rates among adults waitlisted for heart transplant by former medical urgency groups through October 17, 2018
Figure HR 32: Pretransplant mortality rates among adults waitlisted for heart transplant by new medical urgency groups, October 18, 2018, through 2023
Figure HR 33: Pretransplant mortality rates among adults waitlisted for heart transplant in 2023 by DSA
Figure HR 34: Deaths within 6 months after removal among adult heart waitlist candidates, overall
Figure HR 35: Deaths within 6 months after removal among adult heart waitlist candidates, by age
Figure HR 36: Deaths within 6 months after removal among adult heart waitlist candidates, by race and ethnicity
Figure HR 37: Deaths within 6 months after removal among adult heart waitlist candidates, by sex
Figure HR 38: Deaths within 6 months after removal among adult heart waitlist candidates, by status at removal
Figure HR 39: Overall adult heart transplants
Figure HR 40: Adult heart transplants by age
Figure HR 41: Adult heart transplants by sex
Figure HR 42: Adult heart transplants by race and ethnicity
Figure HR 43: Adult heart transplants by diagnosis
Figure HR 44: Adult heart transplants by medical urgency
Figure HR 45: Adult heart transplants by multiorgan transplant type
Figure HR 46: Induction agent use in adult heart transplant recipients
Figure HR 47: Type of induction agent use in adult heart transplant recipients
Figure HR 48: Immunosuppression regimen use in adult heart transplant recipients
Figure HR 49: Patient death among adult heart transplant recipients
Figure HR 50: Patient survival among adult heart transplant recipients, 2016-2018
Figure HR 51: Patient survival among adult heart transplant recipients, 2016-2018, by age
Figure HR 52: Patient survival among adult heart transplant recipients, 2016-2018, by race and ethnicity
Figure HR 53: Patient survival among adult heart transplant recipients, 2016-2018, by diagnosis group
Figure HR 54: Patient survival among adult heart transplant recipients, 2016-2018, by sex
Figure HR 55: Patient survival among adult heart transplant recipients, 2016-2018, by VAD status
Figure HR 56: Patient survival among adult heart transplant recipients, 2016-2018, by former medical urgency
Figure HR 57: Patient survival among adult heart transplant recipients, 2020-2021, by new medical urgency
Figure HR 58: Patient survival among adult heart transplant recipients, 2016-2018, by metropolitan versus nonmetropolitan recipient residence
Figure HR 59: Patient survival among adult heart transplant recipients, 2016-2018, by multiorgan transplant type
Figure HR 60: Patient survival among adult heart transplant recipients, 2016-2018, by cPRA
Figure HR 61: Incidence of acute rejection by 1 year posttransplant among adult heart transplant recipients by age
Figure HR 62: Incidence of PTLD among adult heart transplant recipients by recipient EBV status at transplant, 2012-2018
Figure HR 63: Overall deceased heart donor count
Figure HR 64: Deceased heart donor count by age
Figure HR 65: Distribution of deceased heart donors by age
Figure HR 66: Distribution of deceased heart donors by sex
Figure HR 67: Distribution of deceased heart donors by race and ethnicity
Figure HR 68: Distribution of deceased heart donors by donor HCV status
Figure HR 69: Distribution of deceased heart donors by DCD status
Figure HR 70: Cause of death among deceased heart donors
Figure HR 71: Overall percent of hearts recovered for transplant and not transplanted
Figure HR 72: Percent of hearts recovered for transplant and not transplanted by donor age
Figure HR 73: Percent of hearts recovered for transplant and not transplanted by donor sex
Figure HR 74: Percent of hearts recovered for transplant and not transplanted by donor race and ethnicity
Figure HR 75: Percent of hearts recovered for transplant and not transplanted by donor hypertension status
Figure HR 76: Percent of hearts recovered for transplant and not transplanted by donor BMI
Figure HR 77: Percent of hearts recovered for transplant and not transplanted by donor cause of death
Figure HR 78: Percent of hearts recovered for transplant and not transplanted, by donor risk of disease transmission
Figure HR 79: New pediatric candidates added to the heart transplant waiting list
Figure HR 80: All pediatric candidates on the heart transplant waiting list
Figure HR 81: Distribution of pediatric candidates waiting for heart transplant by age
Figure HR 82: Distribution of pediatric candidates waiting for heart transplant by race and ethnicity
Figure HR 83: Distribution of pediatric candidates waiting for heart transplant by diagnosis
Figure HR 84: Distribution of pediatric candidates waiting for heart transplant by sex
Figure HR 85: Distribution of pediatric candidates waiting for heart transplant by waiting time
Figure HR 86: Distribution of pediatric candidates waiting for heart transplant by medical urgency
Figure HR 87: Three-year outcomes for newly listed pediatric candidates waiting for heart transplant, 2018-2020
Figure HR 88: Overall deceased donor heart transplant rates among pediatric waitlist candidates
Figure HR 89: Deceased donor heart transplant rates among pediatric waitlist candidates by age
Figure HR 90: Deceased donor heart transplant rates among pediatric waitlist candidates by race and ethnicity
Figure HR 91: Deceased donor heart transplant rates among pediatric waitlist candidates by metropolitan versus nonmetropolitan residence
Figure HR 92: Overall pretransplant mortality rates among pediatric candidates waitlisted for heart
Figure HR 93: Pretransplant mortality rates among pediatric candidates waitlisted for heart transplant by age
Figure HR 94: Pretransplant mortality rates among pediatric candidates waitlisted for heart transplant by race and ethnicity
Figure HR 95: Pretransplant mortality rates among pediatric candidates waitlisted for heart transplant by diagnosis
Figure HR 96: Pretransplant mortality rates among pediatric candidates waitlisted for heart transplant by medical urgency
Figure HR 97: Pretransplant mortality rates among pediatric candidates waitlisted for heart transplant by metropolitan versus nonmetropolitan residence
Figure HR 98: Overall pediatric heart transplants
Figure HR 99: Pediatric heart transplants by recipient age
Figure HR 100: Pediatric heart transplants by sex
Figure HR 101: Pediatric heart transplants by race and ethnicity
Figure HR 102: Pediatric heart transplants by diagnosis
Figure HR 103: Pediatric heart transplants by medical urgency
Figure HR 104: Induction agent use in pediatric heart transplant recipients
Figure HR 105: Type of induction agent use in pediatric heart transplant recipients
Figure HR 106: Immunosuppression regimen use in pediatric heart transplant recipients
Figure HR 107: Incidence of acute rejection by 1 year posttransplant among pediatric heart transplant recipients by age
Figure HR 108: Incidence of PTLD among pediatric heart transplant recipients by recipient EBV status at transplant, 2012-2018
Figure HR 109: Patient death among pediatric heart transplant recipients
Figure HR 110: Overall patient survival among pediatric deceased donor heart transplant recipients, 2016-2018
Figure HR 111: Patient survival among pediatric deceased donor heart transplant recipients, 2016-2018, by recipient age
Figure HR 112: Patient survival among pediatric deceased donor heart transplant recipients, 2016-2018, by race and ethnicity
Figure HR 113: Patient survival among pediatric deceased donor heart transplant recipients, 2016-2018, by diagnosis
Figure HR 114: Patient survival among pediatric deceased donor heart transplant recipients, 2016-2018, by medical urgency

List of Tables

Table HR 1: Demographic characteristics of adults on the heart transplant waiting list on December 31, 2013, and December 31, 2023
Table HR 2: Clinical characteristics of adults on the heart transplant waiting list on December 31, 2013, and December 31, 2023
Table HR 3: Listing characteristics of adults on the heart transplant waiting list on December 31, 2013, and December 31, 2023
Table HR 4: Medical urgency statuses 1 and 2 of adults on the heart transplant waiting list by OPTN region during 2022 and 2023
Table HR 5: Heart transplant waitlist activity among adults
Table HR 6: Removal reason among adult heart transplant candidates
Table HR 7: Adult heart transplant recipients on life support before transplant
Table HR 8: Demographic characteristics of adult heart transplant recipients, 2013 and 2023
Table HR 9: Clinical characteristics of adult heart transplant recipients, 2013 and 2023
Table HR 10: Transplant characteristics of adult heart transplant recipients, 2013 and 2023
Table HR 11: Demographic characteristics of pediatric candidates on the heart transplant waiting list on December 31, 2013, and December 31, 2023
Table HR 12: Clinical characteristics of pediatric candidates on the heart transplant waiting list on December 31, 2013, and December 31, 2023
Table HR 13: Listing characteristics of pediatric candidates on the heart transplant waiting list on December 31, 2013, and December 31, 2023
Table HR 14: Heart transplant waitlist activity among pediatric candidates
Table HR 15: Removal reason among pediatric heart transplant candidates
Table HR 16: Pediatric heart transplant recipients on life support before transplant
Table HR 17: Demographic characteristics of pediatric heart transplant recipients, 2013 and 2023
Table HR 18: Clinical characteristics of pediatric heart transplant recipients, 2013 and 2023
Table HR 19: Transplant characteristics of pediatric heart transplant recipients, 2013 and 2023

**New adult candidates added to the heart transplant waiting list.** A new adult candidate is one who first joined the list during the given year, without having been listed in a previous year. Previously listed candidates who underwent transplant and subsequently relisted are considered new. Active and inactive patients are included.

Figure HR 1: New adult candidates added to the heart transplant waiting list. A new adult candidate is one who first joined the list during the given year, without having been listed in a previous year. Previously listed candidates who underwent transplant and subsequently relisted are considered new. Active and inactive patients are included.

**All adult candidates on the heart transplant waiting list.** Adult candidates on the list at any time during the year. Candidates listed at more than one center are counted once per listing.

Figure HR 2: All adult candidates on the heart transplant waiting list. Adult candidates on the list at any time during the year. Candidates listed at more than one center are counted once per listing.

**Distribution of adults waiting for heart transplant by age.** Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive candidates are included. Age is determined at the earliest of transplant, death, removal, or December 31 of the year.

Figure HR 3: Distribution of adults waiting for heart transplant by age. Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive candidates are included. Age is determined at the earliest of transplant, death, removal, or December 31 of the year.

**Distribution of adults waiting for heart transplant by sex.** Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive patients are included.

Figure HR 4: Distribution of adults waiting for heart transplant by sex. Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive patients are included.

**Distribution of adults waiting for heart transplant by race and ethnicity.** Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive patients are included.

Figure HR 5: Distribution of adults waiting for heart transplant by race and ethnicity. Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive patients are included.

**Distribution of adults waiting for heart transplant by diagnosis.** Candidates waiting for transplant at any time in the given year. Active and inactive patients are included. Candidates listed at more than one center are counted once per listing.

Figure HR 6: Distribution of adults waiting for heart transplant by diagnosis. Candidates waiting for transplant at any time in the given year. Active and inactive patients are included. Candidates listed at more than one center are counted once per listing.

**Distribution of adults waiting for heart transplant by waiting time.** Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Time on the waiting list is determined at the earliest of transplant, death, removal, or December 31 of the year. Active and inactive candidates are included.

Figure HR 7: Distribution of adults waiting for heart transplant by waiting time. Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Time on the waiting list is determined at the earliest of transplant, death, removal, or December 31 of the year. Active and inactive candidates are included.

**Distribution of adults waiting for heart transplant by former medical urgency groups through October 17, 2018.** Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive candidates are included. The October 2018 OPTN heart allocation policy update changed the status groups. Medical urgency for 2017 and earlier is determined at the earliest of transplant, death, removal, or December 31 of the year. For 2018 medical urgency statuses, statuses 1A, 1B, and 2 were determined at the earliest of transplant, death, or removal. For candidates who stayed active on the waiting list on or after October 18, 2018, and for candidates who were newly waitlisted on or after that date, their statuses are shown in Figure HR 9. Inactive statuses with new listings on or after October 18, 2018, are excluded here in Figure HR 8.

Figure HR 8: Distribution of adults waiting for heart transplant by former medical urgency groups through October 17, 2018. Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive candidates are included. The October 2018 OPTN heart allocation policy update changed the status groups. Medical urgency for 2017 and earlier is determined at the earliest of transplant, death, removal, or December 31 of the year. For 2018 medical urgency statuses, statuses 1A, 1B, and 2 were determined at the earliest of transplant, death, or removal. For candidates who stayed active on the waiting list on or after October 18, 2018, and for candidates who were newly waitlisted on or after that date, their statuses are shown in Figure HR 9. Inactive statuses with new listings on or after October 18, 2018, are excluded here in Figure HR 8.

**Distribution of adults waiting for heart transplant by new medical urgency groups, October 18, 2018, through 2023.** Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive candidates are included. The October 2018 OPTN heart allocation policy update changed the status groups. Medical urgency is determined at the earliest of transplant, death, removal, or December 31 of the year. For 2018 medical urgency statuses, adult statuses 1-6 and inactive status contain new listings on or after October 18, 2018, or existing listings from before the policy change.

Figure HR 9: Distribution of adults waiting for heart transplant by new medical urgency groups, October 18, 2018, through 2023. Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive candidates are included. The October 2018 OPTN heart allocation policy update changed the status groups. Medical urgency is determined at the earliest of transplant, death, removal, or December 31 of the year. For 2018 medical urgency statuses, adult statuses 1-6 and inactive status contain new listings on or after October 18, 2018, or existing listings from before the policy change.

**Distribution of adults waiting for heart transplant by BMI.** Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive patients are included. BMI, body mass index.

Figure HR 10: Distribution of adults waiting for heart transplant by BMI. Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive patients are included. BMI, body mass index.

**Distribution of adults waiting for heart transplant by blood type.** Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive patients are included.

Figure HR 11: Distribution of adults waiting for heart transplant by blood type. Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive patients are included.

**Distribution of adults waiting for heart transplant by prior transplant status.** Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive patients are included.

Figure HR 12: Distribution of adults waiting for heart transplant by prior transplant status. Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive patients are included.

**Overall deceased donor heart transplant rates among adult waitlist candidates.** Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given year. Individual listings are counted separately.

Figure HR 13: Overall deceased donor heart transplant rates among adult waitlist candidates. Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given year. Individual listings are counted separately.

**Deceased donor heart transplant rates among adult waitlist candidates by age.** Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given year. Individual listings are counted separately. Age is determined at the later of listing date or January 1 of the given year.

Figure HR 14: Deceased donor heart transplant rates among adult waitlist candidates by age. Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given year. Individual listings are counted separately. Age is determined at the later of listing date or January 1 of the given year.

**Deceased donor heart transplant rates among adult waitlist candidates by race and ethnicity.** Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given year. Individual listings are counted separately. The Other race category is composed of Native American and Multiracial categories.

Figure HR 15: Deceased donor heart transplant rates among adult waitlist candidates by race and ethnicity. Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given year. Individual listings are counted separately. The Other race category is composed of Native American and Multiracial categories.

**Deceased donor heart transplant rates among adult waitlist candidates by diagnosis.** Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given year. Individual listings are counted separately.

Figure HR 16: Deceased donor heart transplant rates among adult waitlist candidates by diagnosis. Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given year. Individual listings are counted separately.

**Deceased donor heart transplant rates among adult waitlist candidates by blood type.** Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given year. Individual listings are counted separately.

Figure HR 17: Deceased donor heart transplant rates among adult waitlist candidates by blood type. Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given year. Individual listings are counted separately.

**Deceased donor heart transplant rates among adult waitlist candidates by sex.** Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given year. Individual listings are counted separately.

Figure HR 18: Deceased donor heart transplant rates among adult waitlist candidates by sex. Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given year. Individual listings are counted separately.

**Deceased donor heart transplant rates among adult waitlist candidates by former medical urgency groups through October 17, 2018.** Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given year. Individual listings are counted separately. The October 2018 OPTN heart allocation policy update changed the status groups. Medical urgency is determined at the later of listing date or January 1 of the given year. For new listings on or after October 18, 2018, and for candidates who were newly waitlisted on or after that date, their medical urgency statuses are shown in Figure HR 20. Inactive statuses with new listings on or after October 18, 2018, are excluded here in Figure HR 19.

Figure HR 19: Deceased donor heart transplant rates among adult waitlist candidates by former medical urgency groups through October 17, 2018. Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given year. Individual listings are counted separately. The October 2018 OPTN heart allocation policy update changed the status groups. Medical urgency is determined at the later of listing date or January 1 of the given year. For new listings on or after October 18, 2018, and for candidates who were newly waitlisted on or after that date, their medical urgency statuses are shown in Figure HR 20. Inactive statuses with new listings on or after October 18, 2018, are excluded here in Figure HR 19.

**Deceased donor heart transplant rates among adult waitlist candidates by new medical urgency groups, October 18, 2018, through 2023.** Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given year. Individual listings are counted separately. The October 2018 OPTN heart allocation policy update changed the status groups. Medical urgency is determined at the later of listing date or January 1 of the given year. For 2018 medical urgency statuses, adult statuses 1-6 and inactive status contain new listings on or after October 18, 2018.

Figure HR 20: Deceased donor heart transplant rates among adult waitlist candidates by new medical urgency groups, October 18, 2018, through 2023. Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given year. Individual listings are counted separately. The October 2018 OPTN heart allocation policy update changed the status groups. Medical urgency is determined at the later of listing date or January 1 of the given year. For 2018 medical urgency statuses, adult statuses 1-6 and inactive status contain new listings on or after October 18, 2018.

**Deceased donor heart transplant rates among adult waitlist candidates by height.** Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given year. Individual listings are counted separately.

Figure HR 21: Deceased donor heart transplant rates among adult waitlist candidates by height. Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given year. Individual listings are counted separately.

**Deceased donor heart transplant rates among adult waitlist candidates by metropolitan versus nonmetropolitan residence.** Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given year. Individual listings are counted separately. Urban/rural determination is made using the RUCA (rural-urban commuting area) designation of the candidate's permanent zip code.

Figure HR 22: Deceased donor heart transplant rates among adult waitlist candidates by metropolitan versus nonmetropolitan residence. Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given year. Individual listings are counted separately. Urban/rural determination is made using the RUCA (rural-urban commuting area) designation of the candidate’s permanent zip code.

**Three-year outcomes for adults waiting for heart transplant, new listings in 2020.** Candidates listed at more than one center are counted once per listing. Removed from list includes all reasons except transplant and death. DD, deceased donor.

Figure HR 23: Three-year outcomes for adults waiting for heart transplant, new listings in 2020. Candidates listed at more than one center are counted once per listing. Removed from list includes all reasons except transplant and death. DD, deceased donor.

**Percentage of adults who underwent deceased donor heart transplant within a given period of listing.** Candidates listed at more than one center are counted once per listing.

Figure HR 24: Percentage of adults who underwent deceased donor heart transplant within a given period of listing. Candidates listed at more than one center are counted once per listing.

**Overall pretransplant mortality rates among adults waitlisted for heart transplant.** Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately.

Figure HR 25: Overall pretransplant mortality rates among adults waitlisted for heart transplant. Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately.

**Pretransplant mortality rates among adults waitlisted for heart transplant by age.** Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. Age is determined at the later of listing date or January 1 of the given year.

Figure HR 26: Pretransplant mortality rates among adults waitlisted for heart transplant by age. Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. Age is determined at the later of listing date or January 1 of the given year.

**Pretransplant mortality rates among adults waitlisted for heart transplant by race and ethnicity.** Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. The Other race category is composed of Native American and Multiracial categories.

Figure HR 27: Pretransplant mortality rates among adults waitlisted for heart transplant by race and ethnicity. Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. The Other race category is composed of Native American and Multiracial categories.

**Pretransplant mortality rates among adults waitlisted for heart transplant by sex.** Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately.

Figure HR 28: Pretransplant mortality rates among adults waitlisted for heart transplant by sex. Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately.

**Pretransplant mortality rates among adults waitlisted for heart transplant by diagnosis.** Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately.

Figure HR 29: Pretransplant mortality rates among adults waitlisted for heart transplant by diagnosis. Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately.

**Pretransplant mortality rates among adults waitlisted for heart transplant by metropolitan versus nonmetropolitan residence.** Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. Urban/rural determination is made using the RUCA (rural-urban commuting area) designation of the candidate's permanent zip code.

Figure HR 30: Pretransplant mortality rates among adults waitlisted for heart transplant by metropolitan versus nonmetropolitan residence. Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. Urban/rural determination is made using the RUCA (rural-urban commuting area) designation of the candidate’s permanent zip code.

**Pretransplant mortality rates among adults waitlisted for heart transplant by former medical urgency groups through October 17, 2018.** Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. Medical urgency is determined at the later of listing date or January 1 of the given year. The October 2018 OPTN heart allocation policy update changed the status groups. For 2018 medical urgency statuses, new listings on or after October 18, 2018, are not shown in this figure.

Figure HR 31: Pretransplant mortality rates among adults waitlisted for heart transplant by former medical urgency groups through October 17, 2018. Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. Medical urgency is determined at the later of listing date or January 1 of the given year. The October 2018 OPTN heart allocation policy update changed the status groups. For 2018 medical urgency statuses, new listings on or after October 18, 2018, are not shown in this figure.

**Pretransplant mortality rates among adults waitlisted for heart transplant by new medical urgency groups, October 18, 2018, through 2023.** Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. Medical urgency is determined at the later of listing date or January 1 of the given year. The October 2018 OPTN heart allocation policy update changed the status groups. For 2018 medical urgency statuses, adult statuses 1-6 and inactive status contain new listings on or after October 18, 2018.

Figure HR 32: Pretransplant mortality rates among adults waitlisted for heart transplant by new medical urgency groups, October 18, 2018, through 2023. Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. Medical urgency is determined at the later of listing date or January 1 of the given year. The October 2018 OPTN heart allocation policy update changed the status groups. For 2018 medical urgency statuses, adult statuses 1-6 and inactive status contain new listings on or after October 18, 2018.

**Pretransplant mortality rates among adults waitlisted for heart transplant in 2023 by DSA.** Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. DSA, donation service area.

Figure HR 33: Pretransplant mortality rates among adults waitlisted for heart transplant in 2023 by DSA. Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. DSA, donation service area.

**Deaths within 6 months after removal among adult heart waitlist candidates, overall.** Denominator includes only candidates removed from the waiting list for reasons other than transplant or death while on the list.

Figure HR 34: Deaths within 6 months after removal among adult heart waitlist candidates, overall. Denominator includes only candidates removed from the waiting list for reasons other than transplant or death while on the list.

**Deaths within 6 months after removal among adult heart waitlist candidates, by age.** Denominator includes only candidates removed from the waiting list for reasons other than transplant or death while on the list. Age is determined at removal.

Figure HR 35: Deaths within 6 months after removal among adult heart waitlist candidates, by age. Denominator includes only candidates removed from the waiting list for reasons other than transplant or death while on the list. Age is determined at removal.

**Deaths within 6 months after removal among adult heart waitlist candidates, by race and ethnicity.** Denominator includes only candidates removed from the waiting list for reasons other than transplant or death while on the list. The Other race category is composed of Native American and Multiracial categories.

Figure HR 36: Deaths within 6 months after removal among adult heart waitlist candidates, by race and ethnicity. Denominator includes only candidates removed from the waiting list for reasons other than transplant or death while on the list. The Other race category is composed of Native American and Multiracial categories.

**Deaths within 6 months after removal among adult heart waitlist candidates, by sex.** Denominator includes only candidates removed from the waiting list for reasons other than transplant or death while on the list.

Figure HR 37: Deaths within 6 months after removal among adult heart waitlist candidates, by sex. Denominator includes only candidates removed from the waiting list for reasons other than transplant or death while on the list.

**Deaths within 6 months after removal among adult heart waitlist candidates, by status at removal.** Denominator includes only candidates removed from the waiting list for reasons other than transplant or death while on the list. The October 2018 OPTN heart allocation policy update changed the status groups. The adult statuses listed are for October 18, 2018, and onward. Medical urgency is determined at the earliest of transplant, death, removal, or December 31 of the year.

Figure HR 38: Deaths within 6 months after removal among adult heart waitlist candidates, by status at removal. Denominator includes only candidates removed from the waiting list for reasons other than transplant or death while on the list. The October 2018 OPTN heart allocation policy update changed the status groups. The adult statuses listed are for October 18, 2018, and onward. Medical urgency is determined at the earliest of transplant, death, removal, or December 31 of the year.

Figure HR 39: Overall adult heart transplants. All adult heart transplant recipients, including retransplant and multiorgan recipients.

Figure HR 40: Adult heart transplants by age. All adult heart transplant recipients, including retransplant and multiorgan recipients.

Figure HR 41: Adult heart transplants by sex. All adult heart transplant recipients, including retransplant and multiorgan recipients.

**Adult heart transplants by race and ethnicity.** All adult heart transplant recipients, including retransplant and multiorgan recipients.

Figure HR 42: Adult heart transplants by race and ethnicity. All adult heart transplant recipients, including retransplant and multiorgan recipients.

Figure HR 43: Adult heart transplants by diagnosis. All adult heart transplant recipients, including retransplant and multiorgan recipients.

**Adult heart transplants by medical urgency.** All adult heart transplant recipients, including retransplant and multiorgan recipients. The October 2018 OPTN heart allocation policy update changed the status groups. The statuses 1A, 1B, and 2 listed first are through October 17, 2018, the last day before the policy update; the adult statuses listed are for October 18, 2018, and onward.

Figure HR 44: Adult heart transplants by medical urgency. All adult heart transplant recipients, including retransplant and multiorgan recipients. The October 2018 OPTN heart allocation policy update changed the status groups. The statuses 1A, 1B, and 2 listed first are through October 17, 2018, the last day before the policy update; the adult statuses listed are for October 18, 2018, and onward.

**Adult heart transplants by multiorgan transplant type.** All adult heart transplant recipients, including retransplant and multiorgan recipients.

Figure HR 45: Adult heart transplants by multiorgan transplant type. All adult heart transplant recipients, including retransplant and multiorgan recipients.

Figure HR 46: Induction agent use in adult heart transplant recipients. Immunosuppression at transplant reported to the OPTN.

**Type of induction agent use in adult heart transplant recipients.** Immunosuppression at transplant reported to the OPTN. IL2Ab, interleukin-2 receptor antibody; TCD, T-cell depleting.

Figure HR 47: Type of induction agent use in adult heart transplant recipients. Immunosuppression at transplant reported to the OPTN. IL2Ab, interleukin-2 receptor antibody; TCD, T-cell depleting.

**Immunosuppression regimen use in adult heart transplant recipients.** Immunosuppression regimen at transplant reported to the OPTN. MMF, all mycophenolate agents; Tac, tacrolimus.

Figure HR 48: Immunosuppression regimen use in adult heart transplant recipients. Immunosuppression regimen at transplant reported to the OPTN. MMF, all mycophenolate agents; Tac, tacrolimus.

**Patient death among adult heart transplant recipients.** All adult recipients of deceased donor hearts, including multiorgan transplant recipients.

Figure HR 49: Patient death among adult heart transplant recipients. All adult recipients of deceased donor hearts, including multiorgan transplant recipients.

**Patient survival among adult heart transplant recipients, 2016-2018.** Patient survival estimated using unadjusted Kaplan-Meier methods.

Figure HR 50: Patient survival among adult heart transplant recipients, 2016-2018. Patient survival estimated using unadjusted Kaplan-Meier methods.

**Patient survival among adult heart transplant recipients, 2016-2018, by age.** Patient survival estimated using unadjusted Kaplan-Meier methods.

Figure HR 51: Patient survival among adult heart transplant recipients, 2016-2018, by age. Patient survival estimated using unadjusted Kaplan-Meier methods.

**Patient survival among adult heart transplant recipients, 2016-2018, by race and ethnicity.** Patient survival estimated using unadjusted Kaplan-Meier methods. The Other race category is composed of Native American and Multiracial categories.

Figure HR 52: Patient survival among adult heart transplant recipients, 2016-2018, by race and ethnicity. Patient survival estimated using unadjusted Kaplan-Meier methods. The Other race category is composed of Native American and Multiracial categories.

**Patient survival among adult heart transplant recipients, 2016-2018, by diagnosis group.** Patient survival estimated using unadjusted Kaplan-Meier methods.

Figure HR 53: Patient survival among adult heart transplant recipients, 2016-2018, by diagnosis group. Patient survival estimated using unadjusted Kaplan-Meier methods.

**Patient survival among adult heart transplant recipients, 2016-2018, by sex.** Patient survival estimated using unadjusted Kaplan-Meier methods.

Figure HR 54: Patient survival among adult heart transplant recipients, 2016-2018, by sex. Patient survival estimated using unadjusted Kaplan-Meier methods.

**Patient survival among adult heart transplant recipients, 2016-2018, by VAD status.** Patient survival estimated using unadjusted Kaplan-Meier methods. VAD status at time of transplant. VAD, ventricular assist device.

Figure HR 55: Patient survival among adult heart transplant recipients, 2016-2018, by VAD status. Patient survival estimated using unadjusted Kaplan-Meier methods. VAD status at time of transplant. VAD, ventricular assist device.

**Patient survival among adult heart transplant recipients, 2016-2018, by former medical urgency.** Patient survival estimated using unadjusted Kaplan-Meier methods.

Figure HR 56: Patient survival among adult heart transplant recipients, 2016-2018, by former medical urgency. Patient survival estimated using unadjusted Kaplan-Meier methods.

**Patient survival among adult heart transplant recipients, 2020-2021, by new medical urgency.** Patient survival estimated using unadjusted Kaplan-Meier methods.

Figure HR 57: Patient survival among adult heart transplant recipients, 2020-2021, by new medical urgency. Patient survival estimated using unadjusted Kaplan-Meier methods.

**Patient survival among adult heart transplant recipients, 2016-2018, by metropolitan versus nonmetropolitan recipient residence.** Patient survival estimated using unadjusted Kaplan-Meier methods.

Figure HR 58: Patient survival among adult heart transplant recipients, 2016-2018, by metropolitan versus nonmetropolitan recipient residence. Patient survival estimated using unadjusted Kaplan-Meier methods.

**Patient survival among adult heart transplant recipients, 2016-2018, by multiorgan transplant type.** Patient survival estimated using unadjusted Kaplan-Meier methods.

Figure HR 59: Patient survival among adult heart transplant recipients, 2016-2018, by multiorgan transplant type. Patient survival estimated using unadjusted Kaplan-Meier methods.

**Patient survival among adult heart transplant recipients, 2016-2018, by cPRA.** Patient survival estimated using unadjusted Kaplan-Meier methods. Peak cPRA is used. cPRA, calculated panel-reactive antibody.

Figure HR 60: Patient survival among adult heart transplant recipients, 2016-2018, by cPRA. Patient survival estimated using unadjusted Kaplan-Meier methods. Peak cPRA is used. cPRA, calculated panel-reactive antibody.

**Incidence of acute rejection by 1 year posttransplant among adult heart transplant recipients by age.** Only the first reported rejection event is counted. Cumulative incidence is estimated using the Kaplan-Meier method.

Figure HR 61: Incidence of acute rejection by 1 year posttransplant among adult heart transplant recipients by age. Only the first reported rejection event is counted. Cumulative incidence is estimated using the Kaplan-Meier method.

**Incidence of PTLD among adult heart transplant recipients by recipient EBV status at transplant, 2012-2018.** Cumulative incidence is estimated using the Kaplan-Meier method. PTLD is identified as a reported complication or cause of death on the OPTN Transplant Recipient Follow-up Form or the Posttransplant Malignancy Form as polymorphic PTLD, monomorphic PTLD, or Hodgkin's disease. Only the earliest date of PTLD diagnosis is considered. EBV, Epstein-Barr virus; PTLD, posttransplant lymphoproliferative disorder.

Figure HR 62: Incidence of PTLD among adult heart transplant recipients by recipient EBV status at transplant, 2012-2018. Cumulative incidence is estimated using the Kaplan-Meier method. PTLD is identified as a reported complication or cause of death on the OPTN Transplant Recipient Follow-up Form or the Posttransplant Malignancy Form as polymorphic PTLD, monomorphic PTLD, or Hodgkin’s disease. Only the earliest date of PTLD diagnosis is considered. EBV, Epstein-Barr virus; PTLD, posttransplant lymphoproliferative disorder.

Figure HR 63: Overall deceased heart donor count. Count of deceased donors whose hearts were recovered for transplant.

Figure HR 64: Deceased heart donor count by age. Count of deceased donors whose hearts were recovered for transplant.

Figure HR 65: Distribution of deceased heart donors by age. Deceased donors whose hearts were recovered for transplant.

Figure HR 66: Distribution of deceased heart donors by sex. Deceased donors whose hearts were recovered for transplant.

**Distribution of deceased heart donors by race and ethnicity.** Deceased donors whose hearts were recovered for transplant. The Other race category is composed of Native American and Multiracial categories.

Figure HR 67: Distribution of deceased heart donors by race and ethnicity. Deceased donors whose hearts were recovered for transplant. The Other race category is composed of Native American and Multiracial categories.

**Distribution of deceased heart donors by donor HCV status.** Deceased donors whose hearts were recovered for transplant. Donor HCV status was based on NAT and antibody tests. Ab, antibody; HCV, hepatitis C virus; NAT, nucleic acid test.

Figure HR 68: Distribution of deceased heart donors by donor HCV status. Deceased donors whose hearts were recovered for transplant. Donor HCV status was based on NAT and antibody tests. Ab, antibody; HCV, hepatitis C virus; NAT, nucleic acid test.

**Distribution of deceased heart donors by DCD status.** Deceased donors whose hearts were recovered for transplant. DBD, donation after brain death; DCD, donation after circulatory death.

Figure HR 69: Distribution of deceased heart donors by DCD status. Deceased donors whose hearts were recovered for transplant. DBD, donation after brain death; DCD, donation after circulatory death.

**Cause of death among deceased heart donors.** Deceased donors with a heart recovered for the purposes of transplant. CVA, cerebrovascular accident.

Figure HR 70: Cause of death among deceased heart donors. Deceased donors with a heart recovered for the purposes of transplant. CVA, cerebrovascular accident.

**Overall percent of hearts recovered for transplant and not transplanted.** Percentages of hearts not transplanted out of all hearts recovered for transplant.

Figure HR 71: Overall percent of hearts recovered for transplant and not transplanted. Percentages of hearts not transplanted out of all hearts recovered for transplant.

**Percent of hearts recovered for transplant and not transplanted by donor age.** Percentages of hearts not transplanted out of all hearts recovered for transplant.

Figure HR 72: Percent of hearts recovered for transplant and not transplanted by donor age. Percentages of hearts not transplanted out of all hearts recovered for transplant.

**Percent of hearts recovered for transplant and not transplanted by donor sex.** Percentages of hearts not transplanted out of all hearts recovered for transplant.

Figure HR 73: Percent of hearts recovered for transplant and not transplanted by donor sex. Percentages of hearts not transplanted out of all hearts recovered for transplant.

**Percent of hearts recovered for transplant and not transplanted by donor race and ethnicity.** Percentages of hearts not transplanted out of all hearts recovered for transplant. The Other race category is composed of Native American and Multiracial categories.

Figure HR 74: Percent of hearts recovered for transplant and not transplanted by donor race and ethnicity. Percentages of hearts not transplanted out of all hearts recovered for transplant. The Other race category is composed of Native American and Multiracial categories.

**Percent of hearts recovered for transplant and not transplanted by donor hypertension status.** Percentages of hearts not transplanted out of all hearts recovered for transplant.

Figure HR 75: Percent of hearts recovered for transplant and not transplanted by donor hypertension status. Percentages of hearts not transplanted out of all hearts recovered for transplant.

**Percent of hearts recovered for transplant and not transplanted by donor BMI.** Percentages of hearts not transplanted out of all hearts recovered for transplant. BMI, body mass index.

Figure HR 76: Percent of hearts recovered for transplant and not transplanted by donor BMI. Percentages of hearts not transplanted out of all hearts recovered for transplant. BMI, body mass index.

**Percent of hearts recovered for transplant and not transplanted by donor cause of death.** Percentages of hearts not transplanted out of all hearts recovered for transplant. CVA, cerebrovascular accident.

Figure HR 77: Percent of hearts recovered for transplant and not transplanted by donor cause of death. Percentages of hearts not transplanted out of all hearts recovered for transplant. CVA, cerebrovascular accident.

**Percent of hearts recovered for transplant and not transplanted, by donor risk of disease transmission.** Percentages of hearts not transplanted out of all hearts recovered for transplant. "Risk factors" refers to risk criteria for acute transmission of human immunodeficiency virus, hepatitis B virus, or hepatitis C virus from the US Public Health Service Guideline.

Figure HR 78: Percent of hearts recovered for transplant and not transplanted, by donor risk of disease transmission. Percentages of hearts not transplanted out of all hearts recovered for transplant. “Risk factors” refers to risk criteria for acute transmission of human immunodeficiency virus, hepatitis B virus, or hepatitis C virus from the US Public Health Service Guideline.

**New pediatric candidates added to the heart transplant waiting list.** A new candidate is one who first joined the list during the given year, without having been listed in a previous year. Previously listed candidates who underwent transplant and were subsequently relisted are considered new. Candidates listed at more than one center are counted once per listing. Active and inactive patients are included.

Figure HR 79: New pediatric candidates added to the heart transplant waiting list. A new candidate is one who first joined the list during the given year, without having been listed in a previous year. Previously listed candidates who underwent transplant and were subsequently relisted are considered new. Candidates listed at more than one center are counted once per listing. Active and inactive patients are included.

**All pediatric candidates on the heart transplant waiting list.** Pediatric candidates listed at any time during the year. Candidates listed at more than one center are counted once per listing.

Figure HR 80: All pediatric candidates on the heart transplant waiting list. Pediatric candidates listed at any time during the year. Candidates listed at more than one center are counted once per listing.

**Distribution of pediatric candidates waiting for heart transplant by age.** Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive candidates are included. Age is determined at the earliest of transplant, death, removal, or December 31 of the year. The 18+ category is for candidates who turned age 18 while waiting.

Figure HR 81: Distribution of pediatric candidates waiting for heart transplant by age. Candidates waiting for transplant at any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive candidates are included. Age is determined at the earliest of transplant, death, removal, or December 31 of the year. The 18+ category is for candidates who turned age 18 while waiting.

**Distribution of pediatric candidates waiting for heart transplant by race and ethnicity.** Candidates waiting for transplant any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive candidates are included.

Figure HR 82: Distribution of pediatric candidates waiting for heart transplant by race and ethnicity. Candidates waiting for transplant any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive candidates are included.

**Distribution of pediatric candidates waiting for heart transplant by diagnosis.** Candidates waiting for transplant any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive candidates are included. CM, cardiomyopathy.

Figure HR 83: Distribution of pediatric candidates waiting for heart transplant by diagnosis. Candidates waiting for transplant any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive candidates are included. CM, cardiomyopathy.

**Distribution of pediatric candidates waiting for heart transplant by sex.** Candidates waiting for transplant any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive patients are included.

Figure HR 84: Distribution of pediatric candidates waiting for heart transplant by sex. Candidates waiting for transplant any time in the given year. Candidates listed at more than one center are counted once per listing. Active and inactive patients are included.

**Distribution of pediatric candidates waiting for heart transplant by waiting time.** Candidates waiting for transplant any time in the given year. Candidates listed at more than one center are counted once per listing. Time on the waiting list is determined at the earliest of transplant, death, removal, or December 31 of the year. Active and inactive candidates are included.

Figure HR 85: Distribution of pediatric candidates waiting for heart transplant by waiting time. Candidates waiting for transplant any time in the given year. Candidates listed at more than one center are counted once per listing. Time on the waiting list is determined at the earliest of transplant, death, removal, or December 31 of the year. Active and inactive candidates are included.

**Distribution of pediatric candidates waiting for heart transplant by medical urgency.** Candidates waiting for transplant any time in the given year. Candidates listed at more than one center are counted once per listing. Medical urgency is determined at the earliest of transplant, death, removal, or December 31 of the year. Active and inactive patients are included.

Figure HR 86: Distribution of pediatric candidates waiting for heart transplant by medical urgency. Candidates waiting for transplant any time in the given year. Candidates listed at more than one center are counted once per listing. Medical urgency is determined at the earliest of transplant, death, removal, or December 31 of the year. Active and inactive patients are included.

**Three-year outcomes for newly listed pediatric candidates waiting for heart transplant, 2018-2020.** Pediatric candidates who joined the waiting list in 2018-2020. Pediatric candidates listed at more than one center are counted once per listing. Removed from list includes all reasons except transplant and death. DD, deceased donor.

Figure HR 87: Three-year outcomes for newly listed pediatric candidates waiting for heart transplant, 2018-2020. Pediatric candidates who joined the waiting list in 2018-2020. Pediatric candidates listed at more than one center are counted once per listing. Removed from list includes all reasons except transplant and death. DD, deceased donor.

**Overall deceased donor heart transplant rates among pediatric waitlist candidates.** Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given year. Individual listings are counted separately.

Figure HR 88: Overall deceased donor heart transplant rates among pediatric waitlist candidates. Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given year. Individual listings are counted separately.

**Deceased donor heart transplant rates among pediatric waitlist candidates by age.** Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given year. Individual listings are counted separately. Age is determined at the later of listing date or January 1 of the given year. The 18+ category is for candidates who turned age 18 while waiting.

Figure HR 89: Deceased donor heart transplant rates among pediatric waitlist candidates by age. Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given year. Individual listings are counted separately. Age is determined at the later of listing date or January 1 of the given year. The 18+ category is for candidates who turned age 18 while waiting.

**Deceased donor heart transplant rates among pediatric waitlist candidates by race and ethnicity.** Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given year. Individual listings are counted separately. The Other race category is composed of Native American and Multiracial categories.

Figure HR 90: Deceased donor heart transplant rates among pediatric waitlist candidates by race and ethnicity. Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given year. Individual listings are counted separately. The Other race category is composed of Native American and Multiracial categories.

**Deceased donor heart transplant rates among pediatric waitlist candidates by metropolitan versus nonmetropolitan residence.** Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given year. Individual listings are counted separately.

Figure HR 91: Deceased donor heart transplant rates among pediatric waitlist candidates by metropolitan versus nonmetropolitan residence. Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of waiting time in a given year. Individual listings are counted separately.

**Overall pretransplant mortality rates among pediatric candidates waitlisted for heart.** Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately.

Figure HR 92: Overall pretransplant mortality rates among pediatric candidates waitlisted for heart. Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately.

**Pretransplant mortality rates among pediatric candidates waitlisted for heart transplant by age.** Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. Age is determined at the later of listing date or January 1 of the given year. The 18+ category is for candidates who turned age 18 while waiting.

Figure HR 93: Pretransplant mortality rates among pediatric candidates waitlisted for heart transplant by age. Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. Age is determined at the later of listing date or January 1 of the given year. The 18+ category is for candidates who turned age 18 while waiting.

**Pretransplant mortality rates among pediatric candidates waitlisted for heart transplant by race and ethnicity.** Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. The Other race category is composed of Native American and Multiracial categories.

Figure HR 94: Pretransplant mortality rates among pediatric candidates waitlisted for heart transplant by race and ethnicity. Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. The Other race category is composed of Native American and Multiracial categories.

**Pretransplant mortality rates among pediatric candidates waitlisted for heart transplant by diagnosis.** Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. CM, cardiomyopathy.

Figure HR 95: Pretransplant mortality rates among pediatric candidates waitlisted for heart transplant by diagnosis. Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. CM, cardiomyopathy.

**Pretransplant mortality rates among pediatric candidates waitlisted for heart transplant by medical urgency.** Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. Medical urgency is determined at the later of listing date or January 1 of the given year.

Figure HR 96: Pretransplant mortality rates among pediatric candidates waitlisted for heart transplant by medical urgency. Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. Medical urgency is determined at the later of listing date or January 1 of the given year.

**Pretransplant mortality rates among pediatric candidates waitlisted for heart transplant by metropolitan versus nonmetropolitan residence.** Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. Urban/rural determination is made using the RUCA (rural-urban commuting area) designation of the candidate's permanent zip code.

Figure HR 97: Pretransplant mortality rates among pediatric candidates waitlisted for heart transplant by metropolitan versus nonmetropolitan residence. Mortality rates are computed as the number of deaths per 100 patient-years of waiting time in the given year. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. Urban/rural determination is made using the RUCA (rural-urban commuting area) designation of the candidate’s permanent zip code.

**Overall pediatric heart transplants.** All pediatric heart transplant recipients, including retransplant and multiorgan recipients.

Figure HR 98: Overall pediatric heart transplants. All pediatric heart transplant recipients, including retransplant and multiorgan recipients.

**Pediatric heart transplants by recipient age.** All pediatric heart transplant recipients, including retransplant and multiorgan recipients.

Figure HR 99: Pediatric heart transplants by recipient age. All pediatric heart transplant recipients, including retransplant and multiorgan recipients.

**Pediatric heart transplants by sex.** All pediatric heart transplant recipients, including retransplant and multiorgan recipients.

Figure HR 100: Pediatric heart transplants by sex. All pediatric heart transplant recipients, including retransplant and multiorgan recipients.

**Pediatric heart transplants by race and ethnicity.** All pediatric heart transplant recipients, including retransplant and multiorgan recipients.

Figure HR 101: Pediatric heart transplants by race and ethnicity. All pediatric heart transplant recipients, including retransplant and multiorgan recipients.

**Pediatric heart transplants by diagnosis.** All pediatric heart transplant recipients, including retransplant and multiorgan recipients. CM, cardiomyopathy.

Figure HR 102: Pediatric heart transplants by diagnosis. All pediatric heart transplant recipients, including retransplant and multiorgan recipients. CM, cardiomyopathy.

**Pediatric heart transplants by medical urgency.** All pediatric heart transplant recipients, including retransplant and multiorgan recipients.

Figure HR 103: Pediatric heart transplants by medical urgency. All pediatric heart transplant recipients, including retransplant and multiorgan recipients.

Figure HR 104: Induction agent use in pediatric heart transplant recipients. Immunosuppression at transplant reported to the OPTN.

**Type of induction agent use in pediatric heart transplant recipients.** Immunosuppression at transplant reported to the OPTN. IL2Ab, interleukin-2 receptor antibody; TCD, T-cell depleting.

Figure HR 105: Type of induction agent use in pediatric heart transplant recipients. Immunosuppression at transplant reported to the OPTN. IL2Ab, interleukin-2 receptor antibody; TCD, T-cell depleting.

**Immunosuppression regimen use in pediatric heart transplant recipients.** Immunosuppression regimen at transplant reported to the OPTN. MMF, all mycophenolate agents; Tac, tacrolimus.

Figure HR 106: Immunosuppression regimen use in pediatric heart transplant recipients. Immunosuppression regimen at transplant reported to the OPTN. MMF, all mycophenolate agents; Tac, tacrolimus.

**Incidence of acute rejection by 1 year posttransplant among pediatric heart transplant recipients by age.** Only the first reported rejection event is counted. Cumulative incidence is estimated using the Kaplan-Meier method.

Figure HR 107: Incidence of acute rejection by 1 year posttransplant among pediatric heart transplant recipients by age. Only the first reported rejection event is counted. Cumulative incidence is estimated using the Kaplan-Meier method.

**Incidence of PTLD among pediatric heart transplant recipients by recipient EBV status at transplant, 2012-2018.** Cumulative incidence is estimated using the Kaplan-Meier method. PTLD is identified as a reported complication or cause of death on the OPTN Transplant Recipient Follow-up Form or on the Posttransplant Malignancy Form as polymorphic PTLD, monomorphic PTLD, or Hodgkin's disease. Only the earliest date of PTLD diagnosis is considered. EBV, Epstein-Barr virus; PTLD, posttransplant lymphoproliferative disorder.

Figure HR 108: Incidence of PTLD among pediatric heart transplant recipients by recipient EBV status at transplant, 2012-2018. Cumulative incidence is estimated using the Kaplan-Meier method. PTLD is identified as a reported complication or cause of death on the OPTN Transplant Recipient Follow-up Form or on the Posttransplant Malignancy Form as polymorphic PTLD, monomorphic PTLD, or Hodgkin’s disease. Only the earliest date of PTLD diagnosis is considered. EBV, Epstein-Barr virus; PTLD, posttransplant lymphoproliferative disorder.

**Patient death among pediatric heart transplant recipients.** All pediatric recipients of deceased donor hearts, including multiorgan transplant recipients. Estimates are unadjusted, computed using Kaplan-Meier methods.

Figure HR 109: Patient death among pediatric heart transplant recipients. All pediatric recipients of deceased donor hearts, including multiorgan transplant recipients. Estimates are unadjusted, computed using Kaplan-Meier methods.

**Overall patient survival among pediatric deceased donor heart transplant recipients, 2016-2018.** Recipient survival estimated using unadjusted Kaplan-Meier methods.

Figure HR 110: Overall patient survival among pediatric deceased donor heart transplant recipients, 2016-2018. Recipient survival estimated using unadjusted Kaplan-Meier methods.

**Patient survival among pediatric deceased donor heart transplant recipients, 2016-2018, by recipient age.** Recipient survival estimated using unadjusted Kaplan-Meier methods.

Figure HR 111: Patient survival among pediatric deceased donor heart transplant recipients, 2016-2018, by recipient age. Recipient survival estimated using unadjusted Kaplan-Meier methods.

**Patient survival among pediatric deceased donor heart transplant recipients, 2016-2018, by race and ethnicity.** Recipient survival estimated using unadjusted Kaplan-Meier methods. The Other race category is composed of Native American and Multiracial categories.

Figure HR 112: Patient survival among pediatric deceased donor heart transplant recipients, 2016-2018, by race and ethnicity. Recipient survival estimated using unadjusted Kaplan-Meier methods. The Other race category is composed of Native American and Multiracial categories.

**Patient survival among pediatric deceased donor heart transplant recipients, 2016-2018, by diagnosis.** Recipient survival estimated using unadjusted Kaplan-Meier methods.

Figure HR 113: Patient survival among pediatric deceased donor heart transplant recipients, 2016-2018, by diagnosis. Recipient survival estimated using unadjusted Kaplan-Meier methods.

**Patient survival among pediatric deceased donor heart transplant recipients, 2016-2018, by medical urgency.** Recipient survival estimated using unadjusted Kaplan-Meier methods.

Figure HR 114: Patient survival among pediatric deceased donor heart transplant recipients, 2016-2018, by medical urgency. Recipient survival estimated using unadjusted Kaplan-Meier methods.

Characteristic	2013 N	2013 Percent	2023 N	2023 Percent
Age (years)
18-34 years	350	10.4	302	10.6
35-49	720	21.3	634	22.2
50-64	1,681	49.8	1,397	48.8
65+	623	18.5	529	18.5
Sex
Female	798	23.7	586	20.5
Male	2,576	76.3	2,276	79.5
Race and ethnicity
Asian	83	2.5	70	2.4
Black	790	23.4	875	30.6
Hispanic	244	7.2	306	10.7
Multiracial	15	0.4	19	0.7
Native American	13	0.4	10	0.3
White	2,229	66.1	1,571	54.9
Unreported	0	0	11	0.4
Geography
Metropolitan	2,812	83.3	2,426	84.8
Nonmetropolitan	531	15.7	403	14.1
Missing	31	0.9	33	1.2
Miles between candidate and center
<50 miles	1,999	59.2	1,692	59.1
50-<100	541	16.0	475	16.6
100-<150	324	9.6	268	9.4
150-<250	271	8.0	233	8.1
250+	215	6.4	166	5.8
Missing	24	0.7	28	1.0
All candidates
All candidates	3,374	100.0	2,862	100.0
OPTN/SRTR 2023 Annual Data Report

Characteristic	2013 N	2013 Percent	2023 N	2023 Percent
Diagnosis
Coronary artery disease	1,198	35.5	813	28.4
Cardiomyopathy	1,810	53.6	1,661	58.0
Congenital disease	159	4.7	187	6.5
Valvular disease	47	1.4	20	0.7
Other/unknown	160	4.7	181	6.3
Blood type
A	1,073	31.8	763	26.7
AB	78	2.3	43	1.5
B	394	11.7	266	9.3
O	1,829	54.2	1,790	62.5
VAD status at listing
No VAD	2,449	72.6	1,799	62.9
VAD	908	26.9	1,062	37.1
Missing	17	0.5	1	0.0
Urgency status for heart candidates
Status 1A	325	9.6	0	0
Status 1B	1,328	39.4	0	0
Status 2	908	26.9	0	0
Adult status 1	0	0	19	0.7
Adult status 2	0	0	158	5.5
Adult status 3	0	0	140	4.9
Adult status 4	0	0	1,403	49.0
Adult status 5	0	0	128	4.5
Adult status 6	0	0	551	19.3
Temporarily inactive	813	24.1	463	16.2
All candidates
All candidates	3,374	100.0	2,862	100.0
OPTN/SRTR 2023 Annual Data Report

Characteristic	2013 N	2013 Percent	2023 N	2023 Percent
Previous transplant
No prior transplant	3,256	96.5	2,763	96.5
Prior transplant	118	3.5	99	3.5
Waiting time
<90 days	625	18.5	621	21.7
3-<6 months	513	15.2	362	12.6
6-<12 months	663	19.7	479	16.7
1-<2 years	683	20.2	559	19.5
2+ years	890	26.4	841	29.4
All candidates
All candidates	3,374	100.0	2,862	100.0
OPTN/SRTR 2023 Annual Data Report

Waiting list state	2021	2022	2023
Waiting list state
Patients at start of year	3,146	3,073	2,879
Patients added during year	4,373	4,446	5,063
Patients removed during year	4,446	4,640	5,080
Patients at end of year	3,073	2,879	2,862
OPTN/SRTR 2023 Annual Data Report

Removal reason	2021	2022	2023
Removal reason
Deceased donor transplant	3,355	3,652	4,068
Transplant outside US	0	1	0
Patient died	210	172	154
Patient refused transplant	23	20	20
Improved, transplant not needed	198	157	194
Too sick for transplant	252	212	249
Other	408	425	395
Still on waiting list	0	1	0
OPTN/SRTR 2023 Annual Data Report

OPTN Region	2022 N	2022 Percent	2023 N	2023 Percent
Region 1
Adult status 1	30	6.6	32	7.2
Adult status 2	93	20.5	130	29.3
Region 2
Adult status 1	51	7.4	56	7.9
Adult status 2	175	25.3	221	31.2
Region 3
Adult status 1	55	5.9	90	8.7
Adult status 2	276	29.8	350	33.9
Region 4
Adult status 1	33	4.3	42	5.4
Adult status 2	205	27.0	219	28.1
Region 5
Adult status 1	69	6.7	104	8.8
Adult status 2	345	33.5	365	31.0
Region 6
Adult status 1	11	5.1	16	8.0
Adult status 2	53	24.5	52	26.0
Region 7
Adult status 1	31	4.8	51	7.2
Adult status 2	195	30.0	229	32.4
Region 8
Adult status 1	29	7.1	19	4.8
Adult status 2	130	31.7	164	41.7
Region 9
Adult status 1	45	6.1	51	7.3
Adult status 2	216	29.5	231	33.1
Region 10
Adult status 1	41	5.8	52	6.9
Adult status 2	144	20.5	168	22.1
Region 11
Adult status 1	71	7.5	109	10.4
Adult status 2	268	28.3	311	29.8
OPTN/SRTR 2023 Annual Data Report

Life support type	2020 N	2020 Percent	2023 N	2023 Percent
Life support type
Any life support	2,593	79.8	3,129	76.5
Left ventricular assist device	1,101	33.9	1,523	37.2
Intravenous inotropes	1,283	39.5	1,648	40.3
Intra-aortic balloon pump	871	26.8	868	21.2
Right ventricular assist device	68	2.1	88	2.2
Extra corporeal membrane oxygenation	180	5.5	323	7.9
Total artificial heart	6	0.2	10	0.2
Ventilator	70	2.2	110	2.7
Inhaled nitric oxide	17	0.5	34	0.8
Prostaglandins	1	0.0	6	0.1
OPTN/SRTR 2023 Annual Data Report

Life support type	2018 N	2018 Percent	2023 N	2023 Percent
Life support type
Any life support	352	74.4	346	68.2
Left ventricular assist device	141	29.8	194	38.3
Intravenous inotropes	226	47.8	185	36.5
Intra-aortic balloon pump	0	0	0	0
Right ventricular assist device	27	5.7	36	7.1
Extra corporeal membrane oxygenation	16	3.4	13	2.6
Total artificial heart	3	0.6	0	0
Ventilator	62	13.1	44	8.7
Inhaled nitric oxide	8	1.7	5	1.0
Prostaglandins	10	2.1	7	1.4
OPTN/SRTR 2023 Annual Data Report