Unintended consequences of changes to lung allocation policy

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...

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Bibliographic Details
Published in:American journal of transplantation 2019-08, Vol.19 (8), p.2164-2167
Main Authors: Puri, Varun, Hachem, Ramsey R., Frye, Christian Corbin, Harrison, Margaret Shea, Semenkovich, Tara R., Lynch, John P., Ridolfi, Gene, Rowe, Casey, Meyers, Bryan F., Patterson, George Alexander, Kozower, Benjamin D., Pasque, Michael K., Nava, Ruben G., Marklin, Gary F., Brockmeier, Diane, Sweet, Stuart C., Chapman, William C., Kreisel, Daniel
Format: Article
Language:English
Subjects:
Adult
Buffers
clinical research/practice
donors and donation
editorial/personal viewpoint
Female
Humans
Ischemia
Lung transplantation
Lung Transplantation - standards
lung transplantation/pulmonology
Lung transplants
Male
Middle Aged
organ allocation
organ procurement and allocation
Regional Health Planning - standards
Resource Allocation - legislation & jurisprudence
Tissue and Organ Procurement - organization & administration
Tissue and Organ Procurement - trends
Tissue Donors - supply & distribution
Waiting Lists - mortality
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Summary: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. An analysis of institutional as well as national data indicates that patients transplanted since the lung allocation policy change have largely comparable disease severity, though the cost of donor lungs has increased substantially due to more organs being procured from distant organ procurement organizations. See the editorial from Lehman and Chan on page 2151.
ISSN:1600-6135
1600-6143
DOI:10.1111/ajt.15307