Shipping Lungs Greater Distances Increases Costs Without Cutting Waitlist Mortality

Area of Science:

• Transplantation Medicine
• Health Policy Analysis
• Organ Allocation Systems

Background:

• A 2017 lung allocation policy change replaced donor service areas with a 250-nautical-mile radius to standardize organ distribution.
• This study analyzes the national-level impact of this policy shift on organ acquisition costs and transplant outcomes.

Purpose of the Study:

• To evaluate the consequences of the revised lung allocation policy on organ acquisition costs and patient survival.
• To assess changes in donor utilization and patient outcomes post-policy implementation.

Main Methods:

• Utilized data from the Scientific Registry of Transplant Recipients for adult lung transplant recipients.
• Compared outcomes and costs for patients 30 weeks before and 30 weeks after the policy change.
• Analyzed six-month survival rates using Kaplan-Meier analysis and compared organ acquisition costs.

Main Results:

• Six-month survival rates for transplanted patients remained similar between pre- and post-policy groups.
• Average organ acquisition costs significantly increased post-policy change ($50,735 to $53,440).
• The use of non-local donors increased substantially (44.3% to 68.9%), alongside higher costs and resource utilization.

Conclusions:

• The new lung allocation policy led to increased organ acquisition costs and resource utilization.
• The policy did not result in a decrease in deaths on the waiting list or post-transplant.
• Further optimization of the lung allocation policy is required to balance transplant access with resource stewardship.