ATC Abstracts

American Transplant Congress abstracts

  • Home
  • Meetings Archive
    • 2022 American Transplant Congress
    • 2021 American Transplant Congress
    • 2020 American Transplant Congress
    • 2019 American Transplant Congress
    • 2018 American Transplant Congress
    • 2017 American Transplant Congress
    • 2016 American Transplant Congress
    • 2015 American Transplant Congress
    • 2013 American Transplant Congress
  • Keyword Index
  • Resources
    • 2021 Resources
    • 2016 Resources
      • 2016 Welcome Letter
      • ATC 2016 Program Planning Committees
      • ASTS Council 2015-2016
      • AST Board of Directors 2015-2016
    • 2015 Resources
      • 2015 Welcome Letter
      • ATC 2015 Program Planning Committees
      • ASTS Council 2014-2015
      • AST Board of Directors 2014-2015
      • 2015 Conference Schedule
  • Search

Did the 250 Nautical Mile Circle Work? Geographic Disparities in Lung Transplantation Before and after the Policy Change

M. Kosztowski1, Y. Yu2, A. Massie2, D. L. Segev2, S. E. Gentry2

1University of Iowa, Iowa City, IA, 2Johns Hopkins, Baltimore, MD

Meeting: 2020 American Transplant Congress

Abstract number: 393

Keywords: Allocation, Lung transplantation

Session Information

Session Name: Lung: Let's Start at the Beginning: Pre-Transplant Decision Making and Access to Lung Donors

Session Type: Oral Abstract Session

Date: Saturday, May 30, 2020

Session Time: 3:15pm-4:45pm

 Presentation Time: 3:51pm-4:03pm

Location: Virtual

*Purpose: In November 2017, the lung allocation policy was challenged in court due to concern that candidates living in New York City were being disadvantaged compared to neighboring DSAs. After urgent review, the OPTN/UNOS Executive Committee decided to abandon sharing at the DSA level and implemented a 250 nautical mile (NM) circle as the first unit of allocation. We sought to quantify geographic disparities in lung transplant (LT) rates in the eras before and after the 250 NM circle.

*Methods: We estimated LT rates per active person-year on the waitlist using multilevel Poisson regression and empirical Bayes methods in the eras before and after the policy change. We calculated the median incidence rate ratio (MIRR) which summarizes the between-transplant center variation in LT rates and is a measure of overall geographic disparity. MIRR can be interpreted as the increase in LT rate a candidate could expect if they moved or listed at another transplant center with a higher transplant rate.

*Results: The MIRR before the 250 NM circle was 2.07, and it increased to 2.23 after the policy change. So a candidate could on average increase their LT rate more than two-fold by listing at another transplant center before and after the 250 NM circle. By comparison, an increase in LAS category from 42-50 to 50-100 after the 250 NM circle was associated with a 2.39-fold increase in LT rate (Table 2). There was no clear pattern of change in LT rate by OPTN region with 39 centers experiencing an increase and 34 centers experiencing a decrease (Figure 1B).

*Conclusions: The 250 NM circle was implemented to comply with the Final Rule, but it was not able to eliminate or even reduce geographic disparities in lung transplantation.

 border=

 border=

 border=

  • Tweet
  • Email
  • Print

To cite this abstract in AMA style:

Kosztowski M, Yu Y, Massie A, Segev DL, Gentry SE. Did the 250 Nautical Mile Circle Work? Geographic Disparities in Lung Transplantation Before and after the Policy Change [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/did-the-250-nautical-mile-circle-work-geographic-disparities-in-lung-transplantation-before-and-after-the-policy-change/. Accessed May 11, 2025.

« Back to 2020 American Transplant Congress

Visit Our Partner Sites

American Transplant Congress (ATC)

Visit the official site for the American Transplant Congress »

American Journal of Transplantation

The official publication for the American Society of Transplantation (AST) and the American Society of Transplant Surgeons (ASTS) »

American Society of Transplantation (AST)

An organization of more than 3000 professionals dedicated to advancing the field of transplantation. »

American Society of Transplant Surgeons (ASTS)

The society represents approximately 1,800 professionals dedicated to excellence in transplantation surgery. »

Copyright © 2013-2025 by American Society of Transplantation and the American Society of Transplant Surgeons. All rights reserved.

Privacy Policy | Terms of Use | Cookie Preferences