The new lung allocation system in the United States

Current Opinion in Organ Transplantation

Volumn 11, Issue 5, 2006, Pages 490-495

  Egan, Thomas M ^a  

^a UNIVERSITY OF NORTH CAROLINA   (United States)

Author keywords

Lung allocation score; Transplant benefit; United Network for Organ Sharing Organ Procurement and Transplantation Network (UNOS OPTN) lung allocation policy

Indexed keywords

ALGORITHM; CALCULATION; CLINICAL EFFECTIVENESS; GRAFT RECIPIENT; HEALTH CARE SYSTEM; HISTORY; HUMAN; LUNG INSUFFICIENCY; LUNG TRANSPLANTATION; MEDICAL SERVICE; NEEDS ASSESSMENT; ORGAN DONOR; PEDIATRICS; POSTOPERATIVE PERIOD; REVIEW; SCORING SYSTEM; SURVIVAL; UNITED STATES;

EID: 33748792806     PISSN: 10872418     EISSN: 15317013     Source Type: Journal    
DOI: 10.1097/01.mot.0000244648.93093.89     Document Type: Review

References (18)

1. Reitz BA, Wallwork JL, Hunt SA, et al. Heart-lung transplantation: successful therapy for patients with pulmonary vascular disease. N Engl J Med 1982; 306:557-564.
2. The Toronto Lung Transplant Group. Unilateral lung transplantation for pulmonary fibrosis. N Engl J Med 1986; 314:1140-1145.
3. International guidelines for the selection of lung transplant candidates. Am J Respir Crit Care Med 1998; 158:335-339.
4. Department of Health and Human Services. Organ Procurement and Transplantation Network, Final Rule. 42 CFR - Part 121, Vol. 64: Federal Register; 20 October 1999. pp. 56649-56661.
5. Institute of Medicine, Committee on Non-Heart-Beating Transplantation II. Nonheart-beating organ transplantation: practice and protocols. Washington, DC: National Academy Press; 2000.
6. Egan T. Ethical issues in thoracic organ distribution for transplant. Am J Transplant 2003; 3:366-372.
7. Egan T, Murray S, Bustami R, et al. Development of the new lung allocation system in the United States (chapter IX, OPTN/SRTR Annual Report). Am J Transplant 2006; 6 (5 Pt 2):1212-1227. This article reviews in more detail the history of lung allocation for transplantation in the United States, the rationale for making sweeping changes to the system, and the analyses that were the basis for the new allocation system. Coauthors included SRTR and UNOS staff. The article describes the new system, which ranks candidates based on waiting-list and posttransplant survival probabilities.
8. Egan TM, Edwards LB, Coke MA, et al. Lung allocation in the United States. In: Lynch III JP, Ross D, editors. Lung and heart-lung transplantation. Lung Biology in Health and Disease series, 217. New York: Marcel Dekker Inc. (Taylor & Francis); 2006. pp. 285-300. This chapter discusses the evolution of the new lung allocation system, and reviews the data analyses that led to its development. The new system can be used to rank order all candidates waiting for lung transplantation, and gives equal consideration to benefit (probability of posttransplant survival) and urgency (risk of dying on the waiting list).
9. Hosenpud JD, Bennett LE, Keck BM, et al. Effect of diagnosis on survival benefit of lung transplantation for end-stage lung disease. Lancet 1998; 351:24-27.
10. Egan TM, Bennett LE, Garrity ER, et al. Predictors of death on the UNOS lung transplant waiting list: results of a multivariate analysis [abstract]. J Heart Lung Transplant 2001; 20:242.
11. Egan TM, Bennett LE, Garrity ER, et al. Are there predictors of death at the time of listing for lung transplant? [abstract] J Heart Lung Transplant 2002; 21:154.
12. Egan T, McCullough K, Bustami R, et al. Predictors of death on the UNOS lung transplant waiting list [abstract]. J Heart Lung Transplant 2003; 22:S147.
13. Egan T, McCullough K, Murray S, et al. Risk factors for death after lung transplant in the U.S. [abstract] J Heart Lung Transplant 2003; 22:S146-S147.
14. Liou TG, Adler FR, Fitzsimmons SC, et al. Predictive 5-year survivorship model of cystic fibrosis. Am J Epidemiol 2001; 153:345-352.
15. D'Alonzo GE, Barst RJ, Ayres SM, et al. Survival in patients with primary pulmonary hypertension: results from a national prospective registry. Ann Intern Med 1991; 115:343-349.
16. Egan TM, Kotloff RM. Pro/Con debate: lung allocation should be based on medical urgency and transplant survival and not on waiting time. Chest 2005; 128:407-415. This debate is a spirited discussion of the pros and cons of the new allocation system before it was implemented. There was anxiety in many lung transplant programs that the new system would disenfranchise patients. Dr Kotloff correctly points out that the proposed system was not prospectively validated, but no change to transplant policy has been prospectively validated.
17. Data from OPTN web site (http://www.optn.org) as of 1 March 2006; information is regularly updated.
18. Hoeper MM, Rubin LJ. Update in pulmonary hypertension. Am J Respir Crit Care Med 2006; 173:499-505.