What is it about?
Effective November 24th 2017, the Organ Procurement and Transplantation Network (OPTN),under a directive from the U.S. Department of Health and Human Services(HHS) changed its lung allocation policy. The lungs used to be allocated to the transplant center within the same Organ Procurement Organization (OPO) territory. Since OPO territory are arbitrarily established, a sicker recipient who lives much closer to a donor but outside of the OPO territory might have lower priority than a less sick patient who lives in the donor’s OPO territory. OPOs everywhere in the US have predetermined territory.
Why were those sicker patients not prioritized?
It is because they were not in the same OPO. With the new rules, the priority goes to any recipients for which their transplant center is located within 250 nautical miles of the donor hospital regardless her their OPO territory. The Lung Allocation Score (LAS) still drives the ranking of those patients making the first cut. Basically, lungs are now being offered to the sickest candidates (highest need) in a 250 nautical miles radius from the donor hospital. Any transplant center within that 250 miles radius will have their lung patients on the initial match list offer regardless of OPO and state location.
What will the impact be?
The impact of this change will not be known until at least next year when the OPTN will review the data. We can assume the patients with the highest lung allocation score (LAS) will be transplanted faster than before the new rule. Those will low score will most likely have to wait even longer. States with only one lung transplant center and single OPO like Alabama and Oklahoma won’t automatically have priority at the top of the lung donor list of their in-state OPO. If the donor is located within 250 nautical miles (287 miles) of an out of state transplant center, all those patients will also be at the top of the list. This change in lung allocation will most likely promote an incentive in transplanting sicker patients which is what it should be.
What about the other organs?
Liver allocation also has a similar policy but slightly different. Kidneys and hearts are still allocated mostly based on OPO’s location. Once all organs are allocated by distance instead of OPO location, it might interesting to watch some OPO realignment or merger as their arbitrary territory would become obsolete. In the meantime if you have questions regarding the effect on how it affects you, please ask your transplant coordinator.