For immediate release: Jan. 16, 2018
News — In response to a federal court order, the United Network for Organ Sharing (UNOS) recently made a sudden change to its policy for how donor lungs are allocated to patients on the waiting list for lung transplant.
Under the old policy, since UNOS began to allocate lungs in 1990, patients who live in the same Donor Service Area (DSA) as the hospital where donor lungs are obtained are offered the lungs first. If the lungs are found to not be suitable for any patients inside that DSA, then they can be offered to patients outside the DSA in concentric 500 nautical mile circles.
On Nov. 19, 2017, a patient waiting for a lung transplant in New York City sued to challenge that policy, seeking to broaden the geographical area from which she could be offered donor lungs. A federal trial court quickly ruled in her favor, and an appeals court ordered immediate action.
Then on Friday night, Nov. 24, during the Thanksgiving holiday, UNOS changed the policy to allow allocation of donor lungs within 250 nautical miles of the donor hospital, and dropped the policy of “allocation first within the DSA.”
Thomas M. Egan, MD, MSc, a professor of surgery and adjunct professor of biomedical engineering in the University of North Carolina School of Medicine, says he is "enthusiastically positive about this change, which is long overdue, but not broad enough. This change should have been made a long time ago."
In a commentary published recently in The Journal of Heart and Lung Transplantation, “From six years to five days for organ allocation policy change,” Egan wrote that this change “was a tsunami” that was “sudden, unexpected, and may have huge consequences.”
The Final Rule on Organ Transplant, enacted in 2000, required the OPTN (Organ Procurement and Transplantation Network) contractor (UNOS) to change organ allocation policies to reduce the impact of waiting time and geography. The Final Rule led to the formation of many organ-specific committees. Egan served on the Lung Allocation Subcommittee for six years, and chaired it for five years. This work enacted a novel way to allocate lungs in 2005, based on urgency and transplant benefit instead of waiting time. But Egan couldn’t convince others on the subcommittee or the lung transplant community to change allocation first within a DSA. UNOS persists on local allocation first for most organs, despite the Final Rule.
“It is unclear why a 250 nautical mile radius was chosen instead of allocation within Zone A (500 nautical miles), the next step in the existing lung allocation system. Aside from the additional transportation costs, there is no reason not to consider even broader geographic distribution (at least 1000 nautical miles) of donor lungs,” Egan wrote in his commentary.
“This is a sad day for UNOS and some of the transplant community ... If we cannot produce reasonable rules for equitable allocation of organs in a timely manner, the rules will be made or gerrymandered by those with less understanding of the processes and their complexity.
“Why should this change only be required for lungs?” he wrote. “Either UNOS changes all organ allocation systems to do away with local DSA and regional distribution, and use reasonable distance to allocate organs to those most in need, or more court cases will wash up on the shores of HHS (the U.S. Department of Health and Human Services) and the OPTN (Organ Procurement and Transplantation Network).”
The full commentary is available at:
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