title: Distribution of donor lungs in the United States: a case for broader geographic sharing.
abstract: OBJECTIVE
  To evaluate the association between allocation of donor lungs by geographic sharing type (GST) and lung allocation score (LAS).
  
  
  METHODS
  UNOS data included lung transplant recipients between 5/4/05 and 09/30/15 (n = 17 416) grouped by GST of donor lungs: local, regional, or national. Recipients were stratified by LAS <50, 50-75, and >75. Kaplan-Meier analysis was used to assess five-yr survival.
  
  
  RESULTS
  The majority of lungs were shared locally (n = 9200; 52.8%) followed by nationally (n = 5356; 30.8%) and regionally (n = 2860; 16.4%). There was a significant difference in the mean LAS at transplant (local: 43.7 ± 15; regional: 49.5 ± 18.8; national 51 ± 19.4; p < 0.001). There was a significant association between GST and LAS (p < 0.001). The majority (n = 7431; 58.2%) of recipients with LAS <50 received local lungs. Recipients with LAS >75 received a majority of their organs from national (n = 881; 45.4%) and regional (n = 414; 21.6%) donors. Although statistically significant (p = 0.024), absolute decline in five-yr survival by GST in the national GST was only 1.1% compared to the local GST.
  
  
  CONCLUSIONS
  Nearly half of all lungs in the United States are allocated locally to recipients with an LAS <50. Additional studies should determine if organ sharing over broader geographies would improve waitlist outcomes.
authors.affiliation: Department of Cardiothoracic Surgery, Dartmouth Medical Center, Hanover, NH, USA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Iribarne
authors.affiliation: Center for Health and the Social Sciences (CHESS), University of Chicago, Chicago, IL, USA.|Department of Medicine, University of Chicago, Chicago, IL, USA.
authors.forename: David O
authors.initials: DO
authors.lastname: Meltzer
authors.affiliation: Department of Surgery, Rutgers - New Jersey Medical School, Newark, NJ, USA.
authors.forename: Dhaval
authors.initials: D
authors.lastname: Chauhan
authors.affiliation: Division of Cardiac, Vascular and Thoracic Surgery, Department of Surgery, New York Presbyterian Hospital, Columbia University, New York, NY, USA.
authors.forename: Joshua R
authors.initials: JR
authors.lastname: Sonett
authors.affiliation: Center for Health and the Social Sciences (CHESS), University of Chicago, Chicago, IL, USA.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Gibbons
authors.affiliation: Section of Cardiac and Thoracic Surgery, Department of Surgery, University of Chicago, Chicago, IL, USA.
authors.forename: Wickii
authors.initials: W
authors.lastname: Vigneswaran
authors.affiliation: Department of Surgery, Rutgers - New Jersey Medical School, Newark, NJ, USA.|Newark Beth Israel Medical Center, Barnabas Heart Hospitals, Newark, NJ, USA.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Russo
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D005843:Geography; D015276:Health Care Rationing / Q000706:statistics & numerical data*; D006801:Humans; D008171:Lung Diseases / Q000601:surgery*; D016040:Lung Transplantation; D008297:Male; D018579:Patient Selection; D012720:Severity of Illness Index; D013997:Time Factors; D014019:Tissue Donors / Q000600:supply & distribution*; D009927:Tissue and Organ Procurement / Q000592:standards*; D055815:Young Adult
keywords: United States; donor lung; geographical distribution; lung allocation score; lung transplant