![]() Such limitations may become apparent only several years after implementation. ![]() These lung transplant allocation policies have been designed empirically and are revised over time when limitations appear. For instance, patients with chronic obstructive pulmonary disease (COPD) may be granted a high emergency status in the UK, but not in France, where this status can be granted only to patients with idiopathic pulmonary fibrosis, cystic fibrosis or pulmonary arterial hypertension. However, the criteria to enter the high emergency list vary markedly. In Europe, although two countries have adopted the LAS system (Germany and the Netherlands), most countries rely on a system in which some patients are prioritised under a high emergency status while the remaining receive a graft based on time spent on the waiting list. However, the LAS has been criticised on methodological grounds and is associated with a significant increase in resource use. In 2005, the USA moved from a system based on waiting time to a system based on the expected benefit of LT, the lung allocation score (LAS) system. Health authorities must balance multiple and sometimes conflicting allocation goals, leading to marked variation between countries. Īllocating this scarce resource in an equitable and efficient manner is complex. ![]() Although organ shortage is common in the field of solid organ transplant, it is further aggravated in the case of LT by the very low rates of suitable donors due to the fragility of the lung and the conservative practices of most transplant centres. Despite continuous efforts to expand the pool of donors, the number of available organs is still insufficient to meet the growing demand, leading to deaths on the waiting list and protracted waiting times for those who ultimately undergo LT. Lung transplantation (LT) is the ultimate therapy available for patients with end-stage lung disease. ![]() High emergency organ allocation is an effective strategy to reduce mortality on the waiting list, but causes a disruption of the list equilibrium that may have detrimental long-term effects in situations of significant organ scarcity. Consequently, we observed a progressive increase of mortality on the waiting list (although still lower than with waiting time only), a deterioration of patients’ condition at transplant and a decrease of post-transplant survival times. When the organ/recipient ratio is lower, the benefits in early mortality are larger but are counterbalanced by a dramatic increase of the size of the waiting list. When organ supply is sufficient (>95 organs per 100 patients), it may prevent a small number of early deaths (1 year survival: 93.7% against 92.4% for waiting time only) without significant impact on waiting times or long-term survival. The impact of a high emergency allocation strategy depends largely on the organ supply. We compared the impact of these strategies on waiting time, waiting list mortality and overall survival in various situations of organ scarcity. The model was informed by data from the United Network for Organ Sharing. We developed a simulation model of lung transplantation waiting queues under two allocation strategies, based either on waiting time only or on additional criteria to prioritise the sickest patients. This study aims to assess the short- and long-term effects of a high emergency organ allocation policy on the outcome of lung transplantation. The scarcity of suitable organ donors leads to protracted waiting times and mortality in patients awaiting lung transplantation.
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