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Lung allocation.

Jens Gottlieb1,2

  • 1Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.

Journal of Thoracic Disease
|September 22, 2017
PubMed
Summary
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Lung transplantation (LTx) faces donor lung shortages, increasing waitlist mortality. The Lung Allocation Score (LAS) system improves organ distribution and patient outcomes by prioritizing candidates based on survival prediction.

Area of Science:

  • Transplantation Medicine
  • Organ Allocation Systems
  • Pulmonary Medicine

Background:

  • Donor lung scarcity and expanded lung transplantation (LTx) indications have historically increased waitlist mortality.
  • Traditional donor-recipient matching relies on size (total lung capacity) and blood type, with varied regional or national allocation systems.
  • Ethical principles of equity, justice, beneficence, and utility guide organ distribution, balancing urgency with transplantation outcomes.

Purpose of the Study:

  • To evaluate the impact of urgency status and objective scoring systems on lung transplant waitlist mortality.
  • To assess the effectiveness of the Lung Allocation Score (LAS) in improving organ allocation, transplant activity, and patient outcomes.

Main Methods:

  • Analysis of organ distribution systems, including regional, national, and supranational models.
Keywords:
Lung transplantationlung allocation score (LAS)organ donationorgan procurementwaiting list

Related Experiment Videos

  • Review of urgency determination methods: clinical judgment, audit processes, and objective score systems.
  • Examination of data from approximately 3,500 annual lung transplants, with a focus on the 60% allocated via LAS in the US, Germany, and the Netherlands.

    • Main Results:

    • The Lung Allocation Score (LAS) was developed as a model for predicting post-transplant survival and waitlist survival probability.
    • Clinical implementation of LAS in the US (since 2005) and Germany (since 2011) has shown favorable effects on waitlist outflow, transplant activity, and patient outcomes.
    • Installation of urgency status can decrease mortality for the sickest candidates, provided the proportion of patients on urgency status remains manageable.

    Conclusions:

    • The Lung Allocation Score (LAS) is an effective tool for improving lung organ allocation and patient outcomes.
    • Objective scoring systems like LAS enhance the efficiency and equity of lung transplantation.
    • Future efforts should focus on expanding geographic sharing and refining the LAS model.