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Am J Transplant. 2018 Nov 15. doi: 10.1111/ajt.15182. [Epub ahead of print]

Geographic disparities in lung transplant rates.

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Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, Iowa.
Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland.
Scientific Registry of Transplant Recipients, Minneapolis, Minnesota.
Department of Mathematics, United States Naval Academy, Annapolis, Maryland.


In November 2017, in response to a lawsuit from a New York City lung transplant candidate, an emergency change to the lung allocation policy eliminated the donation service area (DSA) as the first geographic tier of allocation. The lawsuit claimed that DSA borders are arbitrary and that allocation should be based on medical priority. We investigated whether deceased-donor lung transplant (LT) rates differed substantially between DSAs in the United States before the policy change. We estimated LT rates per active person-year using multilevel Poisson regression and empirical Bayes methods. We found that the median incidence rate ratio (MIRR) of transplant rates between DSAs was 2.05, meaning a candidate could be expected to double their LT rate by changing their DSA. This can be compared directly to a 1.54-fold increase in LT rate that we found associated with an increase in lung allocation score (LAS) category from 38-42 to 42-50. Changing a candidate's DSA would have had a greater impact on the candidate's LT rate than changing LAS categories from 38-42 to 42-50. In summary, we found that the DSA of listing was a major determinant of LT rate for candidates across the country before the emergency lung allocation change.


Scientific Registry for Transplant Recipients (SRTR); clinical research/practice; disparities; donors and donation: deceased; health services and outcomes research; lung disease; lung transplantation/pulmonology; organ allocation; organ procurement and allocation


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