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

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

Research output: Contribution to journalArticlepeer-review

13 Scopus citations


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.

Original languageEnglish (US)
Article numbere13655
JournalPediatric Transplantation
Issue number3
StatePublished - May 1 2020


  • behavioral economics
  • decision psychology
  • heart transplantation
  • organ discard rate
  • pediatric transplant

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Transplantation


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