Pediatric Heart Transplantation: When Priority Doesn't Match Urgency | JACC Baran

Pediatric heart transplantation is one of medicine's scarcest resources, where every allocation decision can mean the difference between life and death. But does the current system truly prioritize the children at greatest risk? Hosts Mitsuaki Sawano, MD, and Satoshi Shoji, MD welcome Kazunari Sasaki, MD (Stanford University) to discuss his JACC study, Status Exceptions and Misalignment of Medical Urgency in U.S. Pediatric Heart Transplantation. Using the national OPTN registry of more than 6,000 children awaiting heart transplantation, the study examines whether "status exceptions"—special requests to elevate transplant priority—accurately reflect medical urgency and whether the National Heart Review Board has improved the fairness of organ allocation. The episode explores why well-intentioned exception requests may unintentionally disadvantage the sickest children, how waiting-list mortality varies dramatically within the highest priority category, and why objective measures of medical urgency may be needed to improve equity in donor heart allocation. Dr. Sasaki also shares insights into the evolution of the U.S. transplant system, emerging innovations such as ex vivo heart perfusion, and how data-driven policy can shape the future of pediatric transplantation.

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Episoder(82)

The Lancet: OPTIMA-AF, Is 1 Month Enough After PCI? | JACC Baran

Hosts Mitsuaki Sawano, MD, Shun Kohsaka, MD, Nobuhiro Ikemura, MD, and Satoshi Shoji, MD, welcome Yohei Sotomi, MD, PhD (The University of Osaka), and Ken Kozuma, MD, PhD (Teikyo University) for a spe...

25 Aug 47min

HFpEF: Why Earlier May Be Better | JACC Baran

Hosts Mitsuaki Sawano, MD, Nobuhiro Ikemura, MD, and Satoshi Shoji, MD welcome Shunichi Doi, MD (St. Marianna University School of Medicine) to discuss his JACC: Heart Failure study, Heart Failure Dur...

18 Aug 38min

Post-PCI Hematoma: What IVUS Tells Us | JACC Baran

Percutaneous coronary intervention (PCI) is safer than ever, yet coronary hematoma remains an underrecognized cause of early ischemic complications. In this episode, Host Mitsuaki Sawano, MD welcome T...

11 Aug 35min

PACs: Benign Bystanders or AF in Disguise? | JACC Baran

Premature atrial complexes (PACs) are among the most common arrhythmias encountered in daily practice and are often dismissed as benign. But are they truly harmless—or could some represent the earlies...

28 Jul 35min

Cancer VTE + DOAC: Who Will Bleed? | JACC Baran

Patients with active cancer face a difficult balance: preventing recurrent venous thromboembolism while avoiding major bleeding during anticoagulation. But which patients are truly at highest bleeding...

21 Jul 39min

HFpEF Without Obesity: What Coronary Microcirculation Tells Us | JACC Baran

Host Mitsuaki Sawano, MD, welcomes Kai Nogami, MD (Mayo Clinic), to discuss his JACC Brief Report, "Higher Prevalence of Coronary Microvascular Dysfunction in Patients With HFpEF Without Obesity." Why...

14 Jul 37min

What Autopsy Reveals About MINOCA and Sudden Cardiac Death | JACC Baran

Hosts Mitsuaki Sawano, MD, Kentaro Ejiri, MD, Hiroyuki Sato, MD, and Shun Kosaka, MD welcome Dr. Kosuke Nakasuka, MD, PhD to discuss his JACC study, Sudden Cardiac Death Due to Myocardial Infarction W...

7 Jul 45min