The AHA 2014 meeting presented the results of a study on pediatric heart transplantation: even if patients still had autoantibodies resistant to the new heart, patients who received a heart transplant as soon as a suitable donor was available had a higher expected quality of life than patients who waited for the antibodies to disappear from their bodies before receiving a transplant. On the other hand, the cost of care while waiting for the transplant procedure also needs to be taken into account. The costs associated with having a transplant once a suitable donor is available are also lower than the costs of waiting for a more compatible heart. So, should a pediatric heart transplant be “fast” or “best”? To that end, Dr. Brian Feingold from the University of Pittsburgh Medical Center Children’s Hospital collected data on more than 2,700 pediatric patients enrolled in heart transplantation since 1999. The average age of the patients was 5 years, 45 percent were female, more than half were Caucasian, 23 percent were African-American and 15 percent were Hispanic. Nearly half of the pediatric patients were born with heart disease, but all required urgent new heart transplants. Researchers divided the patients in the registry into two groups according to whether they were waiting for the most suitable heart or not, and compared the 10-year survival rates of the two. The results of the study found that patients who had a transplant once a suitable heart was available had more than one year longer survival, regardless of the effect of antibodies; the overall average cost was$122,856, less than that of patients who waited for the most suitable heart. Just as vaccines activate the body’s immune response system to fight viruses, transplanting an exogenous donor heart into the body triggers the production of anti-graft antibodies. As a result, experts have previously agreed that pediatric patients with antibodies should continue to wait until a heart that does not activate the antibody response becomes available. It would be great if the patient could get the most suitable heart, but while waiting, the patient is in a constant state of limbo. Moreover, nearly 20% of pediatric patients may have associated autoantibodies. In short, in terms of increasing survival rates and reducing costs for pediatric patients, a pediatric heart transplant is the fastest, not the best.