Geographic disparities in donor lung supply and lung transplant waitlist outcomes: A cohort study |
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Authors: | Luke J. Benvenuto David R. Anderson Hanyoung P. Kim Jaime L. Hook Lori Shah Hilary Y. Robbins Frank D'Ovidio Matthew Bacchetta Joshua R. Sonett Selim M. Arcasoy From the Columbia University Lung Transplant Program |
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Affiliation: | 1. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Columbia University Medical Center, New York, NY, USA;2. Department of Management, Zicklin School of Business, Baruch College, New York, NY, USA;3. NewYork‐Presbyterian Hospital, New York, NY, USA;4. Department of Surgery, Columbia University Medical Center, New York, NY, USA |
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Abstract: | Despite the Final Rule mandate for equitable organ allocation in the United States, geographic disparities exist in donor lung allocation, with the majority of donor lungs being allocated locally to lower‐priority candidates. We conducted a retrospective cohort study of 19 622 lung transplant candidates waitlisted between 2006 and 2015. We used multivariable adjusted competing risk survival models to examine the relationship between local lung availability and waitlist outcomes. The primary outcome was a composite of death and removal from the waitlist for clinical deterioration. Waitlist candidates in the lowest quartile of local lung availability had an 84% increased risk of death or removal compared with candidates in the highest (subdistribution hazard ratio [SHR]: 1.84, 95% confidence interval [CI]: 1.51‐2.24, P < .001). The transplantation rate was 57% lower in the lowest quartile compared with the highest (SHR: 0.43, 95% CI: 0.39‐0.47). The adjusted death or removal rate decreased by 11% with a 50% increase in local lung availability (SHR: 0.89, 95% CI: 0.85‐0.93, P < .001) and the adjusted transplantation rate increased by 19% (SHR: 1.19, 95% CI: 1.17‐1.22, P < .001). There are geographically disparate waitlist outcomes in the current lung allocation system. Candidates listed in areas of low local lung availability have worse waitlist outcomes. |
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Keywords: | clinical research/practice donors and donation ethics health services and outcomes research lung transplantation/pulmonology organ allocation organ procurement and allocation United Network for Organ Sharing (UNOS) waitlist management |
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