Shreya Ramineni, Lorenzo D'Angelo, Brandon Ferrell, Vagish Hemmige, Stephen Forest, Daniel B Sims, Omar Saeed, Daniel J Goldstein, Ulrich P Jorde, Shivank Madan
Limited donor organ availability and variable acceptance practices continue to constrain heart transplantation (HT) access in the United States. We examined whether center-level donor offer acceptance (DOA) aggressiveness, measured by the OPTN-introduced DOA ratio was associated with early post-transplant outcomes for 5,393 adult HTs across 106 U.S. transplant centers (January 2024-June 2025). Centers were stratified into restrictive (Q1), intermediate (Q2-Q3), and aggressive (Q4) DOA quartiles. Aggressive-DOA centers utilized older donors, more DCD hearts, and accepted organs with greater travel distances. Despite this, 1-year recipient survival did not differ significantly across DOA groups in either Kaplan-Meier (p=0.253) or adjusted Cox proportional hazards analyses (p=0.277). Rates of severe primary graft dysfunction requiring ECMO, post-transplant stroke, and hemodialysis were also comparable. Aggressive-DOA was moderately correlated with higher center volume. Notably, Aggressive donor heart acceptance was not associated with worse 1-year survival, supporting broader donor utilization to expand HT access without compromising early recipient outcomes.