Lung and Heart Allocation in the United States

Authors

  • M. Colvin-Adams,

    1. Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN
    2. Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, MN
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    • Both authors equally contributed as first author.

  • M. Valapour,

    1. Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN
    2. Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN
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    • Both authors equally contributed as first author.

  • M. Hertz,

    1. Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN
    2. Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN
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  • B. Heubner,

    1. Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN
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  • K. Paulson,

    1. Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN
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  • V. Dhungel,

    1. Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, MN
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  • M. A. Skeans,

    1. Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN
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  • L. Edwards,

    1. United Network for Organ Sharing, Richmond, VA
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  • V. Ghimire,

    1. United Network for Organ Sharing, Richmond, VA
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  • C. Waller,

    1. United Network for Organ Sharing, Richmond, VA
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  • W. S. Cherikh,

    1. United Network for Organ Sharing, Richmond, VA
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  • B. L. Kasiske,

    1. Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN
    2. Department of Medicine, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN
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  • J. J. Snyder,

    1. Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN
    2. Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN
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  • A. K. Israni

    Corresponding author
    1. Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN
    2. Department of Medicine, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN
    3. Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN
      Ajay K. Israni, isran001@umn.edu
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Ajay K. Israni, isran001@umn.edu

Abstract

Lung and heart allocation in the United States has evolved over the past 20–30 years to better serve transplant candidates and improve organ utilization. The current lung allocation policy, based on the Lung Allocation Score, attempts to take into account risk of death on the waiting list and chance of survival posttransplant. This policy is flexible and can be adjusted to improve the predictive ability of the score. Similarly, in response to the changing clinical phenotype of heart transplant candidates, heart allocation policies have evolved to a multitiered algorithm that attempts to prioritize organs to the most infirm, a designation that fluctuates with trends in therapy. The Organ Procurement and Transplantation Network and its committees have been responsive, as demonstrated by recent modifications to pediatric heart allocation and mechanical circulatory support policies and by ongoing efforts to ensure that heart allocation policies are equitable and current. Here we examine the development of US lung and heart allocation policy, evaluate the application of the current policy on clinical practice and explore future directions for lung and heart allocation.

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