Listing patterns at the highest volume heart transplant centers: Multiple roads to transplant

The current heart transplantation (HT) allocation system added additional progressive statuses to differentiate the highest risk patients and decrease waitlist mortality. We analyzed United Network for Organ Sharing thoracic organ data (10/18/2018-6/30/2025) to assess listing practices at the 10 highest volume centers (5,466 total HT). We found variation in the final waitlist status across these centers (status 1 3.6% to 16.4%; status 6 0.5%-14.5%). Further, some centers had more even distributions across final status, while others had dominant status 2 patterns. As continuous distribution allocation is considered for HT, we feel it is critical to consider the practice patterns of these highest-volume centers. Notably, HT candidates may not conform to a prescribed course through escalating statuses.