Expedited Lung Allocation in The Era of Continuous Distribution

Area of Science:

• Transplantation science
• Organ allocation policy
• Medical urgency assessment

Background:

• The use of expedited offers in lung allocation has seen a notable increase.
• Continuous distribution in lung allocation was implemented in March 2023.

Purpose of the Study:

• To identify characteristics of donors, recipients, and offers associated with expedited lung placement.
• To analyze trends in expedited lung offers post-continuous distribution implementation.

Main Methods:

• Retrospective analysis of lung offers accepted for transplant in the US (March 2023-March 2024).
• Data sourced from the Scientific Registry of Transplant Recipients.
• Offers categorized as expedited versus non-expedited.

Main Results:

• 9% (284/3,136) of lung offers were expedited.
• Expedited offers favored male donors (blood type O) and older, male, non-Hispanic recipients with lung condition category A.
• Recipients of expedited offers had lower urgency scores and were less likely to be hospitalized or on life support; one-year survival was higher, though 30-day survival was similar.

Conclusions:

• Expedited lung placements are linked to recipients with lower medical acuity.
• Further policy adjustments are recommended to balance organ placement optimization with equity and recipient outcomes.