Equitable distribution in pediatric heart transplantation. Arguments in favor of a national list.

The disparity between the supply and demand for pediatric donor hearts remains the major constraint in pediatric heart transplantation. This disparity draws attention to the importance of an equitable distribution policy for pediatric hearts. An examination of the policy on pediatric heart distribution shows that although a governmental task force recommended that these organs be allocated according to a national list, the current policy, developed by the United Network of Organ Sharing, emphasizes the local distribution of pediatric hearts. The decision to allocate organs locally was based on both theoretical and practical concerns about national distribution. In analyzing these concerns, we conclude not only that a national list may be a more equitable means of distribution but also that the arguments against a national list no longer justify a policy favoring local distribution. We suggest, therefore, that the time has come to reconsider implementation of a national list for pediatric heart distribution.