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The current system for allocating donated lungs based on proximityand not on need appears to decrease the potential benefits of lungtransplantation and increase the number of patients who diewaiting, researchers said at an annual meeting of thoracic surgeonsin Fort Lauderdale, Fla. Using data provided by the United Network for Organ Sharing (UNOS),study author Mark J Russo, MD, MS, and colleagues at the Universityof Chicago and Columbia University found that donor lungs wereroutinely allocated to less urgent, local candidates even whenthere were patients within the region but outside the local donorservice who were in much greater need. Among the 580 locally allocated double-lung transplants performedin 2009, 480 less needy candidates, or 83 percent of alldouble-lung transplants, received the organs even though awell-matched candidate in greater need existed in the region. Twenty-four percent of such cases involved skipping over regionalcandidates with lung allocation scores - which range from 1 to 100,based on need and likely benefit - more than 10 points higher thanthe local recipient. More than 7 percent of the events involved aregional candidate with a lung allocation score (LAS) more than 25points higher than the local recipient. Overall, 185 of thebypassed regional candidates ultimately died on the waitlist. More than a decade ago, the U.S. Department of Health and HumanServices issued the "Final Rule," intended to ensure that organswere allocated "based on medical criteria, not accidents ofgeography." The new data, however, show that where a transplantcandidate lives continues to influence access to donated lungs. "We found that too often, and to many patients' detriment, organsare allocated according to geography rather than urgency," saidRusso, assistant professor of surgery at the University of ChicagoMedicine. When lungs go to less needy candidates within the localDonor Service Area and never become available to sicker candidatesat the regional or national level, "this decreases the overallbenefits of a transplant," he said. One unfortunate but not unusual example was a 27-year-old man with cystic fibrosis who was in an intensive care unit awaiting a lung transplant. Hehad a lung allocation score of 91 out of 100, one of the highest ofsuch scores in the U.S. at the time. He was expected to die withina week without a transplant. An appropriately matched lung donor did became available less than20 miles from the hospital where this man was waiting, but becausethe candidate was just outside of the donor's local service area,two candidates from within the service area, each with an LAS inthe 40s, took priority. One of these candidates received theorgans. Five days later the 27-year-old patient died. Such circumstances are not uncommon, Russo said. "Ideally, a suitable donor organ would be available for everyperson who could benefit from transplantation," he said."Unfortunately, there remains a critical scarcity of donor organs.More efficient allocation of this scarce and precious resourcecould dramatically increase the overall benefit from lungtransplantation." Russo and colleagues previously demonstrated that 82 percent oflung transplants went to patients with an LAS of less than 50. Forpatients in this low-priority group, five-year life expectancy evenwithout transplant is good - better than 50 percent. For these patients, early transplantation brings limited survivalbenefit, he said. "At the same time," Russo said, "candidates most in need and whocould receive the greatest benefit are dying at high rates withoutthe benefit of transplantation." Most patients with high LAS arestill alive after five years if they get transplanted quickly, butvery few of those who do not get an organ survive more than a fewmonths. This study considered only double-lung candidates. It did notfactor in the possibility of national matching or allow for bloodgroups to be crossed. As a result, "it likely underestimates thefrequency of these events and lives lost," Russo said. "Despiterecent improvements in lung allocation, significant inefficienciesremain, resulting in diminished net benefit from transplantationand lost lives." Additional References Citations. I am an expert from skf16.com, while we provides the quality product, such as China Cylindrical Roller Bearing , Thin-wall Bearing, Deep Groove Ball Bearing ,and more.
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