title: Broader Geographic Sharing of Pediatric Donor Lungs Improves Pediatric Access to Transplant.
abstract: US pediatric transplant candidates have limited access to lung transplant due to the small number of donors within current geographic boundaries, leading to assertions that the current lung allocation system does not adequately serve pediatric patients. We hypothesized that broader geographic sharing of pediatric (adolescent, 12-17 years; child, <12 years) donor lungs would increase pediatric candidate access to transplant. We used the thoracic simulated allocation model to simulate broader geographic sharing. Simulation 1 used current allocation rules. Simulation 2 offered adolescent donor lungs across a wider geographic area to adolescents. Simulation 3 offered child donor lungs across a wider geographic area to adolescents. Simulation 4 combined simulations 2 and 3. Simulation 5 prioritized adolescent donor lungs to children across a wider geographic area. Simulation 4 resulted in 461 adolescent transplants per 100 patient-years on the waiting list (range 417-542), compared with 206 (range 180-228) under current rules. Simulation 5 resulted in 388 adolescent transplants per 100 patient-years on the waiting list (range 348-418) and likely increased transplant rates for children. Adult transplant rates, waitlist mortality, and 1-year posttransplant mortality were not adversely affected. Broader geographic sharing of pediatric donor lungs may increase pediatric candidate access to lung transplant.
authors.affiliation: Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: W M
authors.initials: WM
authors.lastname: Tsuang
authors.affiliation: Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor, MI.
authors.forename: K M
authors.initials: KM
authors.lastname: Chan
authors.affiliation: Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN.
authors.forename: M A
authors.initials: MA
authors.lastname: Skeans
authors.affiliation: Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN.
authors.forename: J
authors.initials: J
authors.lastname: Pyke
authors.affiliation: Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN.|Department of Medicine, University of Minnesota, Minneapolis, MN.
authors.forename: M I
authors.initials: MI
authors.lastname: Hertz
authors.affiliation: Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN.|Department of Medicine, University of Minnesota, Minneapolis, MN.|Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN.
authors.forename: A J
authors.initials: AJ
authors.lastname: Israni
authors.affiliation: United Network for Organ Sharing, Richmond, VA.
authors.forename: L
authors.initials: L
authors.lastname: Robbins-Callahan
authors.affiliation: Division of Pulmonary and Respiratory Diseases, Boston Children's Hospital, Boston, MA.
authors.forename: G
authors.initials: G
authors.lastname: Visner
authors.affiliation: Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN.
authors.forename: X
authors.initials: X
authors.lastname: Wang
authors.affiliation: Department of Surgery, Indiana University School of Medicine, Indianapolis, IN.
authors.forename: T C
authors.initials: TC
authors.lastname: Wozniak
authors.affiliation: Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH.|Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN.
authors.forename: M
authors.initials: M
authors.lastname: Valapour
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006297:Health Services Accessibility / Q000639:trends*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016040:Lung Transplantation / Q000639:trends*; D008297:Male; D011379:Prognosis; D012040:Regional Health Planning / Q000639:trends; D012111:Residence Characteristics; D040841:Resource Allocation / Q000639:trends*; D014019:Tissue Donors / Q000600:supply & distribution*; D009927:Tissue and Organ Procurement / Q000458:organization & administration / Q000639:trends*; D014850:Waiting Lists; D055815:Young Adult
keywords: Scientific Registry for Transplant Recipients (SRTR); donation; donors; health services and outcomes research; lung transplantation; pulmonology