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Broader Geographic Sharing of Adolescent Lung Donors Improves Allocation Efficiency

W. Tsuang,1 J. Pyke,2 M. Skeans,2 K. Chan,4 T. Wozniak,3 A. Israni,2 M. Hertz,4 B. Kasiske,2 M. Valapour,1 J. Snyder.2

1Cleveland Clinic, Cleveland, OH
2SRTR, MMRF, Minneapolis, MN
3IN University, Indianapolis, IN
4University of MI, Ann Arbor, MI
5University of MN, Minneapolis, MN.

Meeting: 2015 American Transplant Congress

Abstract number: 121

Keywords: Allocation, Lung transplantation, Pediatric

Session Information

Date: Sunday, May 3, 2015

Session Name: Concurrent Session: Lung: Optimizing Outcomes

Session Time: 4:00pm-5:30pm

 Presentation Time: 4:36pm-4:48pm

Location: Room 115-C

Related Abstracts
  • Results of Broader Sharing of Young Pediatric Donor Lungs and Priority Allocation System for Young Pediatric Lung Candidates
  • Implications of the Statewide Sharing Variance on Kidney Transplantation Geographic Inequity and Allocation Efficiency

Allocating pediatric donor lungs to pediatric lung transplant (TXP) candidates results in better graft function. However, 87% of adolescent (ADL) donor lungs are allocated to adults. We hypothesized broader geographic sharing of pediatric lungs will increase pediatric to pediatric transplants without impacting adults. We studied US TXP candidates from July 1, 2009, to June 30, 2011. Current policy offers ADL donor lungs sequentially to ADL (ages 12-17 years), child (≤11 years), and adult (≥18 years) candidates in the local donor service areas (DSA) before expanding offers in 500-mile radius increments until organ acceptance. Child lungs are offered to children in the local DSA+1000-mile radius, then to ADL in the DSA+500-mile radius, then to adults in the DSA. We used the SRTR thoracic simulation allocation model to simulate broader geographic sharing. Simulation 1: offer ADL donor lungs to ADL, then children in a 1000-mile radius, then adults in the local DSA. Simulation 2: offer child donor lungs to children, then ADL in the local DSA+1000-mile radius, then adults in the DSA. Simulation 1 resulted in twice the ADL TXP compared to current rules (442.5 ADL TXP per 100 patient-years on the waiting list, range 386.5-488.4, vs. 205.7, range 180.0-228.0). Simulation 2 resulted in TXP rates similar to rates under current rules. Combining simulations 1 and 2 resulted in 461 ADL TXP per 100 patient-years (range 417.2-541.8) with no increase in child TXP rates. Under simulation 1 and combined 1 and 2, the proportion of ADL to ADL TXP increased by 80%. In all simulations, adult TXP and waitlist mortality rates were similar to rates under current rules. Broader geographic sharing of ADL donor lungs may increase allocation efficiency for ADL without adversely affecting children and adults. Our findings may be explained by the small number of child TXP, higher utilization of ADL donor lungs, or preferential LAS system allocation to the sickest adults.

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To cite this abstract in AMA style:

Tsuang W, Pyke J, Skeans M, Chan K, Wozniak T, Israni A, Hertz M, Kasiske B, Valapour M, Snyder J. Broader Geographic Sharing of Adolescent Lung Donors Improves Allocation Efficiency [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/broader-geographic-sharing-of-adolescent-lung-donors-improves-allocation-efficiency/. Accessed April 15, 2021.

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