Lung and Heart Allocation in the United States

Lung and heart allocation in the United States has evolved over the past 20–30 years to better serve transplant candidates and improve organ utilization. The current lung allocation policy, based on the Lung Allocation Score, attempts to take into account risk of death on the waiting list and chance...

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Bibliographic Details
Published in:American journal of transplantation 2012-12, Vol.12 (12), p.3213-3234
Main Authors: Colvin‐Adams, M., Valapour, M., Hertz, M., Heubner, B., Paulson, K., Dhungel, V., Skeans, M. A., Edwards, L., Ghimire, V., Waller, C., Cherikh, W. S., Kasiske, B. L., Snyder, J. J., Israni, A. K.
Format: Article
Language:English
Subjects:
Biological and medical sciences
Heart allograft
Heart Transplantation - statistics & numerical data
Heart Transplantation - trends
Humans
lung allograft
Lung Transplantation - statistics & numerical data
Lung Transplantation - trends
Medical sciences
organ allocation
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Tissue and Organ Procurement - trends
transplant waiting list
transplantation
United States
Waiting Lists
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Summary:Lung and heart allocation in the United States has evolved over the past 20–30 years to better serve transplant candidates and improve organ utilization. The current lung allocation policy, based on the Lung Allocation Score, attempts to take into account risk of death on the waiting list and chance of survival posttransplant. This policy is flexible and can be adjusted to improve the predictive ability of the score. Similarly, in response to the changing clinical phenotype of heart transplant candidates, heart allocation policies have evolved to a multitiered algorithm that attempts to prioritize organs to the most infirm, a designation that fluctuates with trends in therapy. The Organ Procurement and Transplantation Network and its committees have been responsive, as demonstrated by recent modifications to pediatric heart allocation and mechanical circulatory support policies and by ongoing efforts to ensure that heart allocation policies are equitable and current. Here we examine the development of US lung and heart allocation policy, evaluate the application of the current policy on clinical practice and explore future directions for lung and heart allocation. This special article examines the development of US lung and heart allocation policy, evaluates the application of the current policy to clinical practice, and explores future directions, reflecting ongoing efforts to ensure that lung and heart allocation policies are equitable and current. Also see article by Smith et al on page 3191.
ISSN:1600-6135
1600-6143
DOI:10.1111/j.1600-6143.2012.04258.x