Donor Lung Allocation System: Pro-, Cons and Unmet Needs

Chambers DC, Cherikh WS, Harhay MO, Hayes D, Hsich E, Khush KK, et al. The international thoracic organ transplant registry of the international society for heart and lung transplantation: Thirty-sixth adult lung and heart-lung transplantation Report-2019; focus theme: donor and recipient size match. J Heart Lung Transpl. 2019;38(10):1042–55. https://doi.org/10.1016/j.healun.2019.08.001.

Article  Google Scholar 

Valapour M, Lehr CJ, Schladt DP, Smith JM, Swanner K, Weibel CJ, et al. Am J Transpl. 2024;24(2S1):S394–456. https://doi.org/10.1016/j.ajt.2024.01.017. OPTN/SRTR 2022 Annual Data Report: Lung.

Egan TM, Murray S, Bustami RT, Shearon TH, McCullough KP, Edwards LB, et al. Development of the new lung allocation system in the united States. Am J Transpl. 2006;6(5 Pt 2):1212–27. https://doi.org/10.1111/j.1600-6143.2006.01276.x.

Article  CAS  Google Scholar 

Egan TM, Edwards LB. Effect of the lung allocation score on lung transplantation in the united States. J Heart Lung Transpl. 2016;35(4):433–9. https://doi.org/10.1016/j.healun.2016.01.010.

Article  Google Scholar 

https://unos.org/wp-content/uploads/unos/lung-allocation-score.pdf. Accessed.

https://optn.transplant.hrsa.gov/policies-bylaws/public-comment/modify-pediatric-lung-policy/. Accessed.

Benvenuto LJ, Anderson MR, Aversa M, Snyder ME, Robbins H, Shah L, et al. Geographic disparities in lung transplantation in the united States before and after the November 2017 allocation change. J Heart Lung Transpl. 2022;41(3):382–90. https://doi.org/10.1016/j.healun.2021.11.002.

Article  Google Scholar 

Russo MJ, Meltzer D, Merlo A, Johnson E, Shariati NM, Sonett JR, et al. Local allocation of lung donors results in transplanting lungs in lower priority transplant recipients. Ann Thorac Surg. 2013;95(4):1231–4. https://doi.org/10.1016/j.athoracsur.2012.11.070. discussion 4–5.

https://optn.transplant.hrsa.gov/media/2314/broader_sharing_lungs_20171124.pdf. Accessed.

https://optn.transplant.hrsa.gov/media/2815/20190116_thoracic_committee_report_lung.pdf. Accessed.

Valapour M, Lehr CJ, Wey A, Skeans MA, Miller J, Lease ED. Expected effect of the lung composite allocation score system on US lung transplantation. Am J Transpl. 2022;22(12):2971–80. https://doi.org/10.1111/ajt.17160.

Article  Google Scholar 

https://optn.transplant.hrsa.gov/media/psqlcdlz/faq-for-continuous-distribution-of-lungs.pdf. Accessed.

Stewart DE, Wood DW, Alcorn JB, Lease ED, Hayes M, Hauber B, et al. A revealed preference analysis to develop composite scores approximating lung allocation policy in the U.S. BMC Med Inf Decis Mak. 2021;21(1):8. https://doi.org/10.1186/s12911-020-01377-7.

Article  Google Scholar 

Lung Continuous Distribution Three Month Monitoring Report,, July OPTN. 13, 2023, https://optn.transplant.hrsa.gov/media/fzhh1e5r/data_report_lung_committee_cd_07_13_2023.pdf. The pre-policy era was December 7, 2022– March 8, 2023, and the post-policy era was March 9, 2023– June 8, 2023.: Accessed.

https://optn.transplant.hrsa.gov/media/5xjpasun/lung_blood-type_special-pc-summer-2023.pdf. Accessed.

https://optn.transplant.hrsa.gov/media/c0wnzsca/lung_bloodtype_specialpcsummer2023_presentation.pdf

Lung Continuous Distribution 18-Month Monitoring Report. https://optn.transplant.hrsa.gov/media/ndicxb1i/data_report_lung_cd_18month_20241212.pdf Accessed.

Valapour M, Lehr CJ, Schladt DP, Swanner K, Poff K, Handarova D, et al. Am J Transpl. 2025;25(2S1):S422–89. https://doi.org/10.1016/j.ajt.2025.01.025. OPTN/SRTR 2023 Annual Data Report: Lung.

Rose J, Gunsalus PR, Lehr CJ, Swiler MF, Dalton JE, Valapour M. A supply-based scoring approach to account for biological disadvantages in accessing lung transplant. J Heart Lung Transpl. 2025;44(2):193–201. https://doi.org/10.1016/j.healun.2024.09.022.

Article  Google Scholar 

Li SS, Pugacheva A, Singh R, Rabi SA, Michel E, Kreso A et al. Going the distance: geographic effects of the lung transplant composite allocation score. JHLT Open. 2024;6.

ASIJA R, al. e. Early effects of the composite allocation score on lung transplantation in critically ill patients. chest. 2024;166(4):A6316–7.

Google Scholar 

Raddawi M, Laothamatas K, Grewal HS, Magda G, Shah L, Robbins HY et al. Improvement in wait list mortality for the most critically ill since the implementation of the CAS [abstract]. Am J Respir Crit Care Med; 2025.

Banga A, Hartley C, Tulu Z, MacArthur JW, Dhillon G. Impact of continuous distribution as the allocation strategy on lung transplantation. Am J Transpl. 2025. https://doi.org/10.1016/j.ajt.2025.02.001.

Article  Google Scholar 

Krishnan Aea. Donor profile changes with the lung composite allocation score. J Heart Lung Transplantation. 2024;43(4).

Villavicencio MA, Kashem MA, Loor G, Hartwig M, Bottinger B, Ius F, et al. Impact of cold ischemic time on morbidity And mortality after lung transplantation. An updated Analysis of the international multicenter extracorporeal life support in lung transplantation registry. J Heart Lung Transplantation. 2021;40(4):S64.

Google Scholar 

Mupfudze TG, Hawkins CJ, Weiss S, Goff RR, Lyden GR, Lease ED, et al. Factors associated with waitlist clinical deterioration among united States lung transplant recipients under the continuous distribution system. J Heart Lung Transpl. 2025;44(3):412–21. https://doi.org/10.1016/j.healun.2024.10.032.

Article  Google Scholar 

Puri V, Hachem RR, Frye CC, Harrison MS, Semenkovich TR, Lynch JP, et al. Unintended consequences of changes to lung allocation policy. Am J Transpl. 2019;19(8):2164–7. https://doi.org/10.1111/ajt.15307.

Article  Google Scholar 

Tai D, Dhar A, Yusuf A, Marshall A, O’Beirne J, Patch D, et al. The Royal free hospital ‘hub-and-spoke network model’ delivers effective care and increased access to liver transplantation. Public Health. 2018;154:164–71. https://doi.org/10.1016/j.puhe.2017.10.012.

Article  CAS  PubMed  Google Scholar 

Alderete IS, Medina CK, Halpern SE, Pontula A, Hartwig MG. Implications of the composite allocation score system for lung transplantation in the united states: review of the new system. Semin Thorac Cardiovasc Surg. 2024. https://doi.org/10.1053/j.semtcvs.2024.09.001.

Article  PubMed  Google Scholar 

Comments (0)

No login
gif