Abstract
Over the past three decades, lung transplantation has evolved as a recognized treatment for patients with advanced lung disease. However, lung transplantation has remained limited by the shortage of acceptable donor lung organs. Previously, allocation of donor lungs in the USA was based primarily upon a recipient’s wait list time. However, in 2005, under the mandate of the US Department of Health and Human Services, the lung allocation system was changed in order to incorporate medical urgency and to ensure equitable and efficient allocation for all transplant candidates. Clinical criteria that predicted wait list mortality and 1-year post-transplant survival were incorporated into the lung allocation score (LAS). The LAS has been associated with an increased number of wait list candidates, decreased wait list time, decreased wait list mortality, and a change in the clinical characteristics of the lung transplant candidates. Given the success of the LAS in the USA, several European transplant organizations are considering adopting a similar lung allocation schema. Continued refinement of the donor lung allocation schema in the USA and Europe will optimize lung transplant outcomes.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Yusen RD, Edwards LB, Kucheryavaya AY, Benden C, Dipchand AI, Goldfarb SB, Levvey BJ, Lund LH, Meiser B, Rossano JW, Stehlik J. The registry of the International Society for Heart and Lung Transplantation: thirty-second official adult lung and heart-lung transplantation report—2015; focus theme: early graft failure. J Heart Lung Transplant. 2015;34(10):1264–77. This registry highlights the most recent clinical characteristics of lung transplant recipients in the world.
Charman SC et al. Assessment of survival benefit after lung transplantation by patient diagnosis. J Heart Lung Transplant. 2002;21(2):226–32.
UNOS, fact sheet: UNOS transplantation history https://www.unos.org/transplantation/history/ Accessed July 2016. 2015.
OPTN/SRTR, OPTN/SRTR 1990 Annual report of the US Scientific Registry for Transplant Recipients and the Organ Procurement and Transplantation Network—transplant data: 1988-1991. Richmond (VA); Bethesda (MD) 1990.
Eberlein M, Garrity ER, Orens JB. Lung allocation in the United States. Clin Chest Med. 2011;32:213–22.
Hachem RR, Trulock EP. The new lung allocation system and its impact on waitlist characteristics and post-transplant outcomes. Semin Thorac Cardiovasc Surg. 2008;20:139–42.
United network for organ sharing. A guide to calculating the lung allocation score. http://www.unos.org/docs/lung_allocation_score.pdf.
Organ procurement and transplantation network. Policy 10. Allocation of thoracic organs. June 2016]; Available from: http://optn.transplant.hrsa.gov/ContentDocuments/OPTN_Policies.pdf#named-dest=Policy_10.
OPTN, changes to the lung allocation system; https://optn.transplant.hrsa.gov/news/changes-to-the-lung-allocation-system/. 2015.
Valapour M, Skeans MA, Heubner BM, Smith JM, Schnitzler MA, Hertz MI, Edwards LB, Snyder JJ, Israni AK, Kasiske BL. OPTN/SRTR 2012 annual data report: lung. Am J Transplant. 2014;14(Suppl 1):139–65. This report highlights the current data regarding the wait list and transplant characteristics over time in the United States.
Egan TM, Edwards LB. Effect of the lung allocation score on lung transplantation in the United States. J Heart Lung Transplant. 2016;35:433–9.
Maxwell BG, Mooney JJ, Lee PHU, Levitt JE, Chhatwani L, Nicolls MR, Zamora MR, Valentine V, Weill D, Dhillon GS. Increased resource use in lung transplant admissions in the lung allocation score era. Am J Respir Crit Care Med. 2015;191:302–8. An important paper that discusses the increased resource utilization asociated with implementation of the LAS in the US.
Smits JM, Nossent GD, de Vries E, et al. Evaluation of the lung allocation score in highly urgent and urgent lung transplant candidates in Eurotransplant. J Heart Lung Transplant. 2011;30(1):22–8.
Gottlieb J, Greer M, Sommerwerck U, et al. Introduction of the lung allocation score in Germany. Am J Transplant. 2014;14:1318–27.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
Sangeeta Bhorade and Hector Cajigas declare no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Additional information
This article is part of the Topical Collection on Thoracic Transplantation
Rights and permissions
About this article
Cite this article
Cajigas, H.R., Bhorade, S.M. Current Perspectives on Lung Allocation Schemes in the USA and Europe. Curr Transpl Rep 3, 375–379 (2016). https://doi.org/10.1007/s40472-016-0132-7
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40472-016-0132-7