Local Allocation of Lung Donors Results in Transplanting Lungs in Lower Priority Transplant Recipients

Russo, Mark J.; Meltzer, David O.; Merlo, Álvaro Roberto Crespo; Johnson, Elizabeth; Shariati, Nazly; Sonett, Joshua R.; Gibbons, Robert D.

doi:10.1016/j.athoracsur.2012.11.070

Cited by 29 publications

(31 citation statements)

References 4 publications

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“…A number of other studies explored geographic disparities in lung transplantation . For each lung transplant, there are on average 5.96 candidates in each UNOS region with a higher LAS who are bypassed for a transplant when the local DSA is used as the first unit of allocation . Low local lung availability, defined as the ratio of donor lungs to waitlist candidates in a DSA, was associated with lower lung transplant rates and higher mortality/removal from the waitlist .…”

Section: Discussionmentioning

confidence: 99%

Geographic disparities in lung transplant rates

Kosztowski

Zhou

Bush

et al. 2019

American Journal of Transplantation

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In November 2017, in response to a lawsuit from a New York City lung transplant candidate, an emergency change to the lung allocation policy eliminated the donation service area (DSA) as the first geographic tier of allocation. The lawsuit claimed that DSA borders are arbitrary and that allocation should be based on medical priority. We investigated whether deceased‐donor lung transplant (LT) rates differed substantially between DSAs in the United States before the policy change. We estimated LT rates per active person‐year using multilevel Poisson regression and empirical Bayes methods. We found that the median incidence rate ratio (MIRR) of transplant rates between DSAs was 2.05, meaning a candidate could be expected to double their LT rate by changing their DSA. This can be compared directly to a 1.54‐fold increase in LT rate that we found associated with an increase in lung allocation score (LAS) category from 38‐42 to 42‐50. Changing a candidate's DSA would have had a greater impact on the candidate's LT rate than changing LAS categories from 38‐42 to 42‐50. In summary, we found that the DSA of listing was a major determinant of LT rate for candidates across the country before the emergency lung allocation change.

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Section: Discussionmentioning

confidence: 99%

Geographic disparities in lung transplant rates

Kosztowski

Zhou

Bush

et al. 2019

American Journal of Transplantation

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“…Currently, the sickest, highest acuity patients, which comprise less than 10% of the lung transplant waitlist, account for 60% of waitlist deaths [18]. The majority of donor lungs (81%) are allocated within a DSA to a low-acuity, low priority patient even when a matched higher acuity patient exists just outside the boundaries in a separate DSA, resulting in an avoidable waitlist death [18, 19].…”

Section: Disparities In Allocationmentioning

confidence: 99%

“…The majority of donor lungs (81%) are allocated within a DSA to a low-acuity, low priority patient even when a matched higher acuity patient exists just outside the boundaries in a separate DSA, resulting in an avoidable waitlist death [18, 19]. Thus, the current geographic boundaries may limit access for the sickest waitlisted patients to lung transplant.…”

Section: Disparities In Allocationmentioning

confidence: 99%

Contemporary Issues in Lung Transplant Allocation Practices

Tsuang

2017

Curr Transpl Rep

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Purpose of Review To discuss the current state of donor lung allocation in the United States, and future opportunities to increase the efficiency of donor lung allocation. Recent Findings The current donor lung allocation system prioritizes clinical acuity by use of the Lung Allocation Score (LAS) which has reduced waitlist mortality since its implementation in 2005. Access to donor lungs can be further improved through policy changes using broader geographic sharing, and developing new technology such as ex vivo lung perfusion to recover marginal donor lungs. Summary The number of lung transplants in the U.S. continues to increase annually. However, the demand for donor lungs continues to be outpaced by an ever growing waitlist. Efficient allocation can be achieved through improved allocation policies and new technology.

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“…A consequence is that many US patients receive lungs with lower LAS than would occur if lungs were offered over a broader geographic area. In one calendar year, 83% of double lung transplant procedures were performed in recipients with lower LAS than size‐matched ABO‐compatible recipients in the same region . Although a national allocation system may not be practical in the United States, and Germany is much smaller than the United States, the German experience suggests that broader geographic sharing should result in transplanting patients with a higher LAS.…”

Section: Characteristics Of Lung Allocation Systems Pre‐ and Post‐lasmentioning

confidence: 99%