# Don't Throw Your Heart Away: Decision Processes Explain the High Discard Rate of Pediatric Donor Hearts

> **NIH NIH F30** · CARNEGIE-MELLON UNIVERSITY · 2020 · $50,520

## Abstract

PROJECT SUMMARY/ABSTRACT
Heart transplant is the therapeutic gold standard for children with end-stage heart failure. Surprisingly, most
pediatric transplant teams refuse at least one - if not several - of the donor hearts each of their patients is offered.
Indeed, almost half of all hearts offered to pediatric candidates through the UNOS allocation system are
discarded altogether. In light of the high waitlist mortality rates for children waiting heart transplants, the pattern
of donor discard indicates a need to better understand the behavioral factors underlying transplant team decision
making. Previous literature suggests that federal regulatory agencies place too much emphasis on post-
transplant outcomes when auditing program performance. Additionally, publicly available outcome assessments
for transplant programs do not make salient that some programs tend to reject many of the hearts they are
offered, whereas other programs accept a broader range of donor offers. Taken together, both federal regulators
and public reports incentivize transplant teams to maximize transplant success above other outcomes, and
programs may respond by using selective donor acceptance strategies to achieve this goal. This project uses a
framework from behavioral economics—blending the scientific disciplines of conventional economics and
decision psychology— to uncover the decision processes that influence donor evaluation. The central hypothesis
is that decisions surrounding the tradeoff between waitlist time and transplant success depend on what outcome
information is presented for evaluation and how that information is presented, which we address through two
specific aims: (1) Evaluate the association between transplant mortality rates and subsequent donor offer refusal
rates at pediatric heart transplant centers; (2) Examine how the presentation of performance information affects
transplant center evaluations by laypersons, patients, and clinical personnel. Hierarchical linear modeling of
pediatric heart transplant data from the Organ Procurement and Transplant Network database is used to identify
whether center-level low performance evaluations are associated with subsequent increases in donor refusal for
quality reasons (Aim 1). Empirical studies are used to test whether performance data that reflect center donor
acceptance rates influence laypersons, patients, and other stakeholders to evaluate centers with high organ
decline rates less favorably than centers with low organ decline rates (Aim 2). The proposed research is
innovative because although psychological influences surrounding donor evaluation have been acknowledged,
behavioral research has not yet been applied to the challenge of donor discard in practice. This project provides
ideal training for a future physician-scientist through exposure to a high-stakes issue at the intersection of clinical
medicine, behavioral research, and health policy. The training plan incorporates an interdisciplinary p...

## Key facts

- **NIH application ID:** 9990979
- **Project number:** 1F30HL152526-01
- **Recipient organization:** CARNEGIE-MELLON UNIVERSITY
- **Principal Investigator:** Alison Elaine Butler
- **Activity code:** F30 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $50,520
- **Award type:** 1
- **Project period:** 2020-07-15 → 2024-07-14

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9990979

## Citation

> US National Institutes of Health, RePORTER application 9990979, Don't Throw Your Heart Away: Decision Processes Explain the High Discard Rate of Pediatric Donor Hearts (1F30HL152526-01). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/9990979. Licensed CC0.

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