title: Lung and heart allocation in the United States.
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.
authors.affiliation: Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN, USA.
authors.forename: M
authors.initials: M
authors.lastname: Colvin-Adams
authors.forename: M
authors.initials: M
authors.lastname: Valapour
authors.forename: M
authors.initials: M
authors.lastname: Hertz
authors.forename: B
authors.initials: B
authors.lastname: Heubner
authors.forename: K
authors.initials: K
authors.lastname: Paulson
authors.forename: V
authors.initials: V
authors.lastname: Dhungel
authors.forename: M A
authors.initials: MA
authors.lastname: Skeans
authors.forename: L
authors.initials: L
authors.lastname: Edwards
authors.forename: V
authors.initials: V
authors.lastname: Ghimire
authors.forename: C
authors.initials: C
authors.lastname: Waller
authors.forename: W S
authors.initials: WS
authors.lastname: Cherikh
authors.forename: B L
authors.initials: BL
authors.lastname: Kasiske
authors.forename: J J
authors.initials: JJ
authors.lastname: Snyder
authors.forename: A K
authors.initials: AK
authors.lastname: Israni
mesh_terms: D016027:Heart Transplantation / Q000706:statistics & numerical data / Q000639:trends*; D006801:Humans; D016040:Lung Transplantation / Q000706:statistics & numerical data / Q000639:trends*; D009927:Tissue and Organ Procurement / Q000639:trends*; D014481:United States; D014850:Waiting Lists