Lung transplantation: the new lung-allocation system

Lung transplantation has evolved over the past two decades as a well-recognized therapy for patients with end-stage lung diseases. However, lung transplantation has been limited, in part, due to the scarcity of donor lung organs. Previously, donor lung organs were allocated based on a potential recipient's waiting list time. However, in 2005, under the mandate of the US Government, through the Department of Health and Human Services, the lung-allocation system was changed to incorporate medical urgency and utility in order to optimize patient outcomes. Clinical factors that predicted pretransplant and 1-year post-transplant survival for each potential recipient were incorporated into a Lung Allocation Score. Early 1-year results have shown a decrease in the number of candidates on the waiting list, a decrease in the waiting time and a decrease in waiting list mortality. Outcomes after lung transplantation have been conflicting, with some centers suggesting worse outcomes and others suggesting an increased morbidity but not increased 1-year mortality. Longer follow-up of these patients will be useful to determine the utility of the Lung Allocation Score system in lung transplantation.