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OPTN Organ Allocation

My Only Post on Lung Transplants in Children

Only because there’s so much bad information floating around about this.

Development of the New Lung Allocation System in the United States” by Egan et al. From 2006 regarding 2004 allocation changes. 

(emphasis mine)

Pediatric candidates for lung transplantation pose vexing challenges. In young patients, there are serious size constraints for thoracic organs in general and lungs in particular, because of the effect of age and height on the volume of the chest cavity that must accommodate the graft. Fortunately, the incidence of life-limiting lung disease in very young patients is quite low, making the demand for pediatric lungs much less than that seen for adults with end-stage lung diseases. However, the number of sudden deaths leading to organ donation in children is also low, making the number of potential lung donors in this segment of the population also low, and inadequate to meet the demands of lung transplant programs.

Based on analysis of the distribution of diagnoses of waitlisted and transplanted pediatric candidates and recipients, it appeared that there was a difference in diagnosis patterns and incidence of diagnoses among children younger than 10 or 11 years, and among teenagers, whose incidence of certain diagnoses for end-stage lung disease resembled that of a cohort of adults in the third decade of life. Additional analyses of waiting list and post-transplant survival by age for patients younger than 18 years (summarized partially in data tables of the OPTN/SRTR Annual Report) led the Subcommittee to conclude that there appeared to be a ‘break point’ at the age of 12 years. Adolescent and teenage lung transplant recipients aged 12 years and older had similar incidence of diagnoses and waiting list and posttransplant survival to young adults, while children younger than 12 years old had different diagnoses and survival probabilities. Thus, the Subcommittee decided to group all potential recipients younger than 12 years together as a separate group (Group E), place all patients aged 12 years and older in Groups A through D, and repeat the analyses to identify predictors of waiting list and post-transplant survival.

Because of the small number of potential recipients younger than 12 years, risk factors for death cannot be reliably calculated with the available data. After consultation with large-volume pediatric lung transplant programs at Children’s Hospital of Philadelphia and St. Louis Children’s Hospital, Washington University, it was decided that, until sufficient data become available, time on the waiting list remained the most appropriate way to allocate lungs to this small group of patients.

 

The policy is not “arbitrary” nor “not based in science” or not “data supported”. And neither is it a product of the ACA  (aka Obamacare). Any questions?

 

Full article: http://onlinelibrary.wiley.com/doi/10.1111/j.1600-6143.2006.01276.x/full

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