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. 2019 Aug;19(8):2164-2167.
doi: 10.1111/ajt.15307. Epub 2019 Mar 18.

Unintended consequences of changes to lung allocation policy

Varun Puri  1 , Ramsey R Hachem  2 , Christian Corbin Frye  1 , Margaret Shea Harrison  1 , Tara R Semenkovich  1 , John P Lynch  3 , Gene Ridolfi  3 , Casey Rowe  3 , Bryan F Meyers  1 , George Alexander Patterson  1 , Benjamin D Kozower  1 , Michael K Pasque  1 , Ruben G Nava  1 , Gary F Marklin  4 , Diane Brockmeier  4 , Stuart C Sweet  2 , William C Chapman  1 , Daniel Kreisel  1
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Unintended consequences of changes to lung allocation policy

Varun Puri et al. Am J Transplant. 2019 Aug.

Abstract

Organ allocation for transplantation aims to balance the principles of justice and medical utility to optimally utilize a scarce resource. To address practical considerations, the United States is divided into 58 donor service areas (DSA), each constituting the first unit of allocation. In November 2017, in response to a lawsuit in New York, an emergency action change to lung allocation policy replaced the DSA level of allocation for donor lungs with a 250 nautical mile circle around the donor hospital. Similar policy changes are being implemented for other organs including heart and liver. Findings from a recent US Department of Health and Human Services report, supplemented with data from our institution, suggest that the emergency policy has not resulted in a change in the type of patients undergoing lung transplantation (LT) or early postoperative outcomes. However, there has been a significant decline in local LT, where donor and recipient are in the same DSA. With procurement teams having to travel greater distances, organ ischemic time has increased and median organ cost has more than doubled. We propose potential solutions for consideration at this critical juncture in the field of transplantation. Policymakers should choose equitable and sustainable access for this lifesaving discipline.

Keywords: clinical research/practice; donors and donation; editorial/personal viewpoint; lung transplantation/pulmonology; organ allocation; organ procurement and allocation.

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Conflict of interest statement

Disclosure

The authors of this manuscript have no conflicts of interest to disclose as described by the American Journal of Transplantation.

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References

    1. Network OPaT. How Organ Allocation Works. 2017; https://optn.transplant.hrsa.gov/learn/about-transplantation/how-organ-a.... Accessed September 9, 2018.
    1. Services USDoHaH. Organ Procurement and Transplantation Network. 2017; https://optn.transplant.hrsa.gov/media/2397/hrsa_letter_to_optn_20171121.... Accessed Aeptember 9, 2018.
    1. Committee OT. Monitoring of the Lung Allocation Change, 6-Month Report Removal of DSA as a Unit of Allocation. 2018; https://optn.transplant.hrsa.gov/media/2517/20180621_thoracic_committee_.... Accessed September 9, 2018.
    1. Balsara KR, Krupnick AS, Bell JM, et al. A single-center experience of 1500 lung transplant patients. J Thorac Cardiovasc Surg. 2018;156(2):894–905 e893. - PMC - PubMed
    1. Transplantation TISfHaL. International Thoracic Organ Transplant (TTX) Registry Data Slides. 2017; https://ishltregistries.org/registries/slides.asp. Accessed September 9, 2018.

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