Transplants and trust

Much of medicine's effectiveness depends on trust, and that is nowhere clearer than in organ transplantation, which depends on organ donation.  And hearts are uniquely time-sensitive.  Here's a reflection on how to move forward, maintaining trust while promoting efficacy, including by monitoring current policies and carefully analyzing alternatives. (Kurt Sweat is the market design economist on this medical team...) 

 Skowronski, J., K. Sweat, and M. Farr (2025). In transplant we trust? Perspectives on the erosion of trust in the United States transplant system. Journal of Cardiac Failure

 Here's the concluding paragraph:

"Heart transplantation is both a resource-intensive and symbolically resonant form of organ donation. It is also particularly vulnerable: donor scarcity, limited ischemic time, and increasing utilization and scrutiny of DCD magnify the consequences of every unused heart and every erosion of trust. The controversies facing the broader transplant system—questions of allocation, oversight, and ethics—are felt acutely in heart transplantation. The US has long been a leader in transplantation, and as we move forward, we must sustain excellence in outcomes and volume. Avoidable missteps put those on the waitlist at greater risk of deterioration and death. It is essential that OPOs, transplant centers, and policy makers increase transparency in outcomes and the policymaking process. This would entail prospective policy analyses and improved information sharing through OPO and transplant center dashboards. Enacting these policies is vital to restore and enhance trust in the transplant system. In hearts, ischemic time is short, waitlist mortality is high, and donor utilization is low, presenting an opportunity for especially impactful improvements in procedures. In an era that feels perilous and bleak, enhancements to policymaking procedures and outcome reports can improve trust and save lives."