Disparities in lung transplantation

Abstract

In May 2005, the deceased-donor lung allocation system for adolescents and adults in the United States transitioned from one that prioritized candidates with the longest waiting times to one that now prioritizes candidates that have a high risk of death while awaiting transplantation and a high expected survival benefit from transplantation. Implementation of this latter system, termed the Lung Allocation Score (LAS) system, aimed to address a federal mandate to direct organs to those most in need and to minimize the effects of geography. The federal mandate and the LAS system did not specifically aim to address health care disparities based on sex or race. As hoped, implementation of the LAS system was associated with an increase in the number of lung transplants performed each year, a decreased waiting time, and a lower waiting list mortality rate, whereas survival after transplant has remained relatively unchanged compared with outcomes in the pre-LAS era. However, few studies have addressed whether these benefits have had equal distribution among sex, racial, and ethnic groups. Disparities refer to unnecessary, avoidable, unfair, and unjust inequalities that occur among demographically defined groups. Health disparities often adversely affect access to high-quality health care, burden of disease, and outcomes such as death. In the field of lung transplantation, health disparities may result from differential rates of placement on the waiting list, transplantation after waitlisting, and various health outcomes after transplant. In this issue of the Journal, Wille et al report the results from their study that examined associations among race and sex categories and outcomes that included rates of transplantation and death on the waiting list before and after implementation of the LAS donor lung allocation system. The study used United States Organ Procurement