Unintended consequences of changes to lung allocation policy.

Area of Science:

• Transplantation science
• Organ allocation policy
• Public health

Background:

• Organ allocation balances justice and medical utility for scarce resources.
• The US uses donor service areas (DSA) for initial organ allocation.
• A 2017 policy change replaced DSA with a 250-nautical mile radius for lung allocation.

Purpose of the Study:

• To evaluate the impact of the 2017 lung allocation policy change.
• To assess changes in patient selection and early outcomes post-lung transplantation (LT).
• To analyze effects on local LT rates, organ ischemic time, and costs.

Main Methods:

• Analysis of a US Department of Health and Human Services report.
• Inclusion of institutional data on lung transplantation.
• Comparison of pre- and post-policy change metrics.

Main Results:

• No significant change in lung transplant recipient type or early postoperative outcomes.
• A significant decrease in local lung transplants (donor and recipient within the same DSA).
• Increased organ ischemic time and more than doubled median organ costs due to extended travel.

Conclusions:

• The emergency policy has unintended negative consequences on local organ sharing and cost-effectiveness.
• Urgent consideration of policy solutions is required to ensure equitable and sustainable access to transplantation.
• Policymakers must balance resource utilization with fairness in organ allocation.