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New Lung Allocation Policy Could Affect Transplant Outcomes

At 93 percent, one-year patient survival rates for lung transplant at The Johns Hopkins Hospital exceed the national average of 89 percent.

April 11, 2018

In November 2017, the Organ Procurement and Transplantation Network (OPTN) issued a significant change to the way deceased donor lungs are allocated for lung transplants. Instead of first offering the organs based on the lung allocation scores of patients in the local area around a hospital, the lungs are now offered to patients within a 250-mile radius of the donor hospital.

Scientific Registry

At 93 percent, one-year patient survival rates for lung transplant at The Johns Hopkins Hospital exceed the national average of 89 percent.

The OPTN executive committee authorized this action in response to an emergent directive from the secretary of the Department of Health and Human Services to review the rationale for using the donor service area (DSA) as the first level of distribution. The concern was due to the seemingly arbitrary nature of DSA boundaries and the potential that urgent transplant candidates in close proximity to organ donors may not get immediate priority if they are across a DSA boundary.

Watch Errol Bush discuss the recent updates to the lung allocation policy.

Errol Bush, surgical director of the Advanced Lung Disease and Lung Transplant Program in the Johns Hopkins Comprehensive Transplant Center, says time will tell what the effects of the new policy are, but he’s concerned the change could affect the outcomes of lung transplants. Although there is broader sharing of the organs, people with a higher lung allocation score tend to be very sick going into a transplant. Now these patients will be the first to receive a lung transplant.

“We don’t know if placing a higher priority on patients with higher lung allocation scores will end up resulting in poorer outcomes,” says Bush.

The history of lung transplants at The Johns Hopkins Hospital spans nearly 25 years. The median wait time is less than three months, and most patients are released within 10 days after receiving their transplant at Johns Hopkins. The national average for length of stay for a lung transplant is 17 days.

“We’ve developed a very experienced and expert team that is well-accustomed to taking care of patients with lung transplants and helping them to recover with superior outcomes,” says Bush.

Since 2015, Bush and the lung transplant team have completed 58 lung transplants without a mortality. Recent data from the Scientific Registry of Transplant Patients reports the one-year average survival rate after a lung transplant at The Johns Hopkins Hospital is 93 percent, while the national average is 89 percent. Likewise, the three-year survival rate for patients at Johns Hopkins is reported to be 75 percent versus a national average of 72 percent.

Patient indications for a bilateral lung transplant at Johns Hopkins include cystic fibrosis, bronchiectasis, pulmonary hypertension, emphysema and pulmonary fibrosis (idiopathic or secondary to scleroderma or other disease states). Indications for a single lung transplant include emphysema and pulmonary fibrosis.

Easy Access to Transplant Experts 

The new Johns Hopkins Transplant Center app, which was developed specifically for healthcare providers, offers convenient access to Johns Hopkins transplant surgeons, physicians, and referral and patient coordinators. Healthcare providers can quickly obtain contact information for urgent and non-urgent referrals and view information about Johns Hopkins transplant experts by organ group (heart, kidney/pancreas, liver, lung and reconstructive).

Download the physician referral app via iTunes or Google Play, or call 410-614-4898 to refer a patient.

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