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Behavioral economics-A framework for donor organ decision-making in pediatric heart transplantation.

Journal article
Authors Alison Butler
Gretchen Chapman
Jonathan N Johnson
Antonio Amodeo
Jens Böhmer
Manuela Camino
Ryan R Davies
Anne I Dipchand
Justin Godown
Oliver Miera
Alicia Pérez-Blanco
David N Rosenthal
Steve Zangwill
Richard Kirk
Published in Pediatric Transplantation
Volume 24
Issue 3
Pages e13655
ISSN 1397-3142
Publication year 2020
Published at
Pages e13655
Language en
Subject categories Cognitive science, Transplantation surgery, Paediatric cardiology, Pediatrics


The high discard rate of pediatric donor hearts presents a major challenge for children awaiting heart transplantation. Recent literature identifies several factors that contribute to the disparities in pediatric donor heart usage, including regulatory oversight, the absence of guidelines on pediatric donor heart acceptance, and variation among transplant programs. However, a likely additional contributor to this issue are the behavioral factors influencing transplant team decisions in donor offer scenarios, a topic that has not yet been studied in detail. Behavioral economics and decision psychology provide an excellent foundation for investigating decision-making in the pediatric transplant setting, offering key insights into the behavior of transplant professionals. We conducted a systematic review of published literature in pediatric heart transplant related to behavioral economics and the psychology of decision-making. In this review, we draw on paradigms from these two domains in order to examine how existing aspects of the transplant environment, including regulatory oversight, programmatic variation, and allocation systems, may precipitate potential biases surrounding donor offer decisions. Recognizing how human decision behavior influences donor acceptance is a first step toward improving utilization of potentially viable pediatric donor hearts.

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