Interesting study findings in @JAMA_current article published yesterday:

1) The 5-year survival benefit assoc with heart tx varied across centers, and
2) High survival benefit centers performed heart tx for patients with lower estimated waiting list survival without transplant

Link to article: https://jamanetwork.com/journals/jama/fullarticle/2754791

Pretty impressive variation in 5-yr survival benefit across hospitals (although my epi brain is screaming at me for the truncated y-axis, which tends to exaggerate variation).

Figure 3 looks under the hood a bit more to show that the added survival benefit is largely driven by low candidate survival

i.e., centers with the largest survival benefit of heart tx had treated patients with the lowest survival without a heart tx

Note that in the second pane, there was little correlation between post-tx survival and overall survival benefit.

From the discussion:

The new allocation system may mitigate some variability by reserving heart tx for the sickest pts:

"If one applies the new cardiogenic shock criteria conservatively in the 6-tier allocation system, one-third of status 1A recipients would not qualify for
status 1, 2, or 3."

The cynical side of me thinks that changing the rules will just create new incentives to play to the test, such as big upcoding in cardiogenic shock, or even more worrying, greater/more inappropriate use of ECMO, mechanical circ support, or ventilation.

Seems like a ripe area for research down the road, particularly around the potential adverse effects of the new tier allocation system.
cc @boback @mad_sters @iamritu @bnallamo @TomCascinoMD