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Modifications to the distribution of deceased donor lungs

Proposal Overview

Status: Public Comment

Sponsoring Committee: Thoracic Organ Transplantatation Committee

Strategic Goal 2: Provide equity in access to transplants

Read the full proposal (PDF – 797 K; 1/2018)

View proposed lung allocation distribution dashboard [Exit disclaimer]  


On November 24, 2017, the OPTN/UNOS Executive Committee approved an emergency change to lung allocation policy to remove the donation service area (DSA) as a unit of distribution and instead distribute lungs from adult donors to all lung candidates within 250 nautical miles of the donor. DSA level allocation was also removed from the pediatric donor sequence. These changes to policy were implemented immediately. Because this change was made on an emergency basis, it is now being distributed for public comment. By November 24, 2018, the OPTN Board of Directors, upon review of lung allocation policy in light of the requirements of the OPTN final rule, and in consideration of the public comments and feedback received, must take a final action to either: (1) approve this interim policy as a non-interim policy; or (2) approve any other changes to the OPTN lung allocation policy the OPTN Board believes to be more consistent with the requirements of the OPTN final rule.

The Thoracic Organ Transplantation Committee is sponsoring this retrospective public comment proposal, which also includes two additional changes to policy that are required as a consequence of removing the DSA as a unit of distribution from lung allocation policy:

  1. Modifications to Board-approved heart-lung allocation policy that has not yet been implemented
  2. Modifications to policy for sensitized lung candidates

The goal of these changes is to make lung allocation policy more consistent with the OPTN Final Rule, provide more equity in access to transplantation regardless of a candidate’s geography, and to clarify and make more transparent the heart-lung allocation policy. These changes also address how implementation of the new lung allocation policy impacts heart-lung allocation policy and policy addressing sensitized lung candidates.

Contact: Liz Robbins Callahan

Specific questions

The Committee appreciates feedback from the community on the entire proposal, and specifically requests that the community consider the interim policy and alternative policies in light of the requirements of the OPTN Final Rule. Additional questions include:

  1. Is 250 nautical miles from the donor hospital the appropriate first zone of distribution for lungs procured from donors at least 18 years old?
  2. Are the proposed changes to heart-lung allocation policy clear?
  3. Which of the options the Committee considered for sensitized candidates do you prefer?

Members are also asked to comment on both the immediate and long term budgetary impact of resources that may be required if this proposal is approved. This information assists the Board in considering the proposal and its impact on the community.

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