Thoracic organ transplantation.
This article presents an overview of factors associated with thoracic transplantation outcomes over the past decade and provides valuable information regarding the heart, lung, and heart-lung waiting lists and thoracic organ transplant recipients. Waiting list and post-transplant information is used to assess the importance of patient demographics, risk factors, and primary cardiopulmonary disease on outcomes. The time that the typical listed patient has been waiting for a heart, lung, or heart-lung transplant has markedly increased over the past decade, while the number of transplants performed has declined slightly and survival after transplant has plateaued. Waiting list mortality, however, appears to be declining for each organ and for most diseases and high-severity subgroups, perhaps in response to recent changes in organ allocation algorithms. Based on perceived inequity in organ access and in response to a mandate from Health Resources and Services Administration, the lung transplant community is developing a lung allocation system designed to minimize deaths on the waiting list while maximizing the benefit of transplant by incorporating post-transplant survival and quality of life into the algorithm. Areas where improved data collection could inform evolving organ allocation and candidate selection policies are emphasized.
Pierson
Richard N
RN
University of Maryland Medical Center and VA, Baltimore, MD, USA. rpierson@smail.umaryland.edu
Barr
Mark L
ML
McCullough
Keith P
KP
Egan
Thomas
T
Garrity
Edward
E
Jessup
Mariell
M
Murray
Susan
S
D000465:Algorithms; D016027:Heart Transplantation / Q000379:methods / Q000706:statistics & numerical data; D016041:Heart-Lung Transplantation / Q000379:methods / Q000401:mortality / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D016040:Lung Transplantation / Q000379:methods / Q000706:statistics & numerical data; D040841:Resource Allocation / Q000458:organization & administration; D009927:Tissue and Organ Procurement / Q000379:methods / Q000458:organization & administration; D014481:United States; D014850:Waiting Lists