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Improving equity of access/transparency in organ allocation.

Kateryna Krynychka1, Matthew G Hartwig

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The new lung allocation system (CAS) improved transplant rates and reduced waitlist deaths. However, inequities persist for certain patient groups, requiring ongoing policy refinement for equitable organ distribution.

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Area of Science:

  • Transplantation Medicine
  • Health Policy
  • Organ Allocation Systems

Background:

  • Persistent inequities in lung transplant access exist due to biological constraints, geographic variations, and system practices.
  • Urgency-based allocation alone has not fully addressed these disparities.
  • The implementation of continuous distribution and the Composite Allocation Score (CAS) marks a significant policy shift.

Purpose of the Study:

  • To review early evidence on the effectiveness of continuous distribution and CAS in improving fairness and transparency in lung allocation.
  • To identify remaining challenges and disparities in the lung allocation process.

Main Methods:

  • Review of early national and multicenter analyses of lung transplant data.
  • Examination of transplant rates, waitlist mortality, and posttransplant survival.
  • Assessment of access for various patient demographics and sensitization levels.

Main Results:

  • CAS implementation shows increased transplant rates and reduced waitlist mortality without compromising short-term survival.
  • Continuous geographic scoring and biologic disadvantage adjustments improved access for specific groups (e.g., short-statured, women).
  • Disparities persist for blood group O recipients, highly sensitized candidates, and patients at centers with conservative practices. Increased travel distance and allocation out of sequence (AOOS) raise concerns.

Conclusions:

  • Continuous distribution is a significant advancement for equity and transparency in lung allocation.
  • Allocation reform alone cannot eliminate all disparities related to biological limitations, geography, or center practices.
  • Ongoing monitoring, policy refinement, and system standardization are crucial for equitable and ethical donor lung utilization.