Development of the New Lung Allocation System in the United States |
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| Authors: | T M Egan S Murray R T Bustami T H Shearon K P McCullough L B Edwards M A Coke E R Garrity S C Sweet D A Heiney F L Grover |
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| Institution: | Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA;Scientific Registry of Transplant Recipients, University of Michigan, Ann Arbor, MI, USA;Scientific Registry of Transplant Recipients, University Renal Research and Education Association, Ann Arbor, MI, USA;United Network for Organ Sharing, Richmond, VA, USA;Department of Medicine, University of Chicago, Chicago IL, USA;Department of Pediatrics, Washington University, St. Louis, MI, USA;Department of Surgery, University of Colorado, Denver, CO, USA |
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| Abstract: | This article reviews the development of the new U.S. lung allocation system that took effect in spring 2005. In 1998, the Health Resources and Services Administration of the U.S. Department of Health and Human Services published the Organ Procurement and Transplantation Network (OPTN) Final Rule. Under the rule, which became effective in 2000, the OPTN had to demonstrate that existing allocation policies met certain conditions or change the policies to meet a range of criteria, including broader geographic sharing of organs, reducing the use of waiting time as an allocation criterion and creating equitable organ allocation systems using objective medical criteria and medical urgency to allocate donor organs for transplant. This mandate resulted in reviews of all organ allocation policies, and led to the creation of the Lung Allocation Subcommittee of the OPTN Thoracic Organ Transplantation Committee. This paper reviews the deliberations of the Subcommittee in identifying priorities for a new lung allocation system, the analyses undertaken by the OPTN and the Scientific Registry for Transplant Recipients and the evolution of a new lung allocation system that ranks candidates for lungs based on a Lung Allocation Score, incorporating waiting list and posttransplant survival probabilities. |
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| Keywords: | Lung transplantation organ allocation modeling OPTN SRTR transplant benefit waiting list |
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