Our Summary

This research paper discusses the process of deciding who gets a lung transplant in the United States. There are not enough donor lungs to meet demand, and some people are at higher risk of dying while waiting for a transplant than others. Therefore, deciding who gets a transplant first is a complex process.

Until 2023, a system called the Lung Allocation Score (LAS) was used to make this decision. The LAS took into account how ill patients were, how likely they were to die without a transplant, and how likely they were to survive a year after the transplant. However, it didn’t consider factors such as the size of the recipient, whether they had previously had transplants (which can make the body react negatively to a new organ), and their blood type – all of which can affect how many suitable donor lungs are available.

The LAS also didn’t consider social factors that can affect who gets a transplant. This includes where patients live, how much money they have, and their racial or ethnic background. As a result, some groups were less likely to get a transplant and more likely to die while waiting for one.

To address these issues, a new system called the Composite Allocation Score (CAS) was introduced in March 2023. This paper reviews the data showing how these biological and social factors can affect who gets a lung transplant, to explain why they have been included in the new CAS system.

FAQs

  1. What is the Lung Allocation Score (LAS) system and what factors does it consider?
  2. How have social determinants like race, ethnicity, and socioeconomic status influenced lung transplant allocation?
  3. What is the Composite Allocation Score (CAS) and how does it aim to address disparities in lung transplant allocation?

Doctor’s Tip

One helpful tip a doctor might tell a patient about lung transplant is to stay informed and educated about the organ allocation process. Understanding the factors that influence allocation, such as disease severity, recipient size, allosensitization, blood type, and social determinants, can help patients advocate for themselves and improve their chances of receiving a transplant. Additionally, patients should work closely with their healthcare team to ensure they are meeting all necessary criteria and optimizing their health for transplant.

Suitable For

Patients who are typically recommended for lung transplant include those with end-stage lung diseases such as chronic obstructive pulmonary disease (COPD), idiopathic pulmonary fibrosis, cystic fibrosis, and pulmonary hypertension. These patients have severe symptoms and impaired quality of life, and medical treatments are no longer effective in managing their condition. Lung transplant may be recommended when other treatment options have been exhausted and the patient’s prognosis is poor without a transplant.

In addition to disease severity, other factors such as age, overall health, and ability to tolerate surgery and post-transplant medications are also taken into consideration when determining if a patient is a suitable candidate for lung transplant. Patients must also have a strong support system in place to help them through the transplant process and recovery.

It is important to note that lung transplant is not recommended for everyone with end-stage lung disease, and each patient’s case is evaluated individually by a multidisciplinary team of healthcare providers to determine the best course of treatment.

Timeline

Before lung transplant:

  1. Patient is diagnosed with end-stage lung disease and is evaluated by a transplant team.
  2. Patient undergoes extensive medical and psychological evaluations to determine if they are a suitable candidate for a lung transplant.
  3. Patient is placed on the national transplant waiting list and waits for a suitable donor match.
  4. Patient may experience worsening symptoms and decreased quality of life while waiting for a transplant.

After lung transplant:

  1. Patient receives a call that a suitable donor match has been found and undergoes surgery to receive a new lung.
  2. Patient is closely monitored in the intensive care unit post-transplant for any complications.
  3. Patient undergoes rehabilitation and physical therapy to regain strength and lung function.
  4. Patient takes immunosuppressant medications to prevent rejection of the new lung.
  5. Patient attends regular follow-up appointments with their transplant team to monitor their progress and adjust medications as needed.
  6. Patient gradually returns to normal activities and enjoys improved quality of life post-transplant.

What to Ask Your Doctor

  1. What is the lung allocation score (LAS) system and how does it determine organ allocation for lung transplant candidates?
  2. How does recipient size, allosensitization, blood type, and other biologic factors impact the likelihood of receiving a lung transplant?
  3. What social determinants can affect a patient’s chances of receiving a lung transplant?
  4. How does the composite allocation score (CAS) differ from the LAS system and how does it aim to address disparities in lung organ allocation?
  5. What are the potential risks and benefits of receiving a lung transplant?
  6. How long is the typical wait time for a lung transplant and what factors can affect this wait time?
  7. What is the success rate of lung transplants and what are some potential complications or risks associated with the procedure?
  8. How will I need to prepare for a lung transplant surgery and what is the recovery process like?
  9. What kind of follow-up care and monitoring will be necessary after receiving a lung transplant?
  10. Are there any lifestyle changes or medications that will be required after receiving a lung transplant?

Reference

Authors: Calhoun K, Smith J, Gray AL. Journal: Curr Opin Organ Transplant. 2023 Jun 1;28(3):163-167. doi: 10.1097/MOT.0000000000001069. Epub 2023 Apr 18. PMID: 37073809