Abstract
BackgroundThe Swiss organ allocation system for donor lungs was implemented on 1 July 2007. The effects of this implementation on patient selection, intensive care unit course, outcomes and intensive care costs are unknown.MethodsThe first 37 consecutive lung transplant recipients following the implementation of the new act were compared with the previous 42 lung transplant recipients.ResultsFollowing implementation of the new law, baseline characteristics and cumulative one-year patient survival were comparable in both groups (88.1% vs 83.8%, P = 0.58). The costs for each case increased by 35,000 euros after adoption of the new law. Stratifying patients after implementation of the law according to urgency status shows that urgent patients required longer mechanical ventilation (P = 0.04), a longer ICU stay (P = 0.045) and a longer hospital stay (P = 0.04) and ICU costs (median 64,050 euros) were higher compared to regular patients.ConclusionThe new transplantation law has increased ICU costs with the implementation of the Swiss organ allocation system. Patients listed as ‘urgent’ contribute significantly to the increase in ICU costs.
Highlights
Since the first heart–lung transplant was conducted in 1980, the option of transplantation has become the standard of care for selected patients with end-stage pulmonary parenchymal or pulmonary vascular disorders [1]
The main diagnoses leading to lung transplantation are chronic obstructive lung disease (34.6%), idiopathic pulmonary fibrosis (IPF)
This is the first study to evaluate the effect of the implementation of the Swiss Organ Allocation System on intensive care unit (ICU) outcomes and resource utilization
Summary
Since the first heart–lung transplant was conducted in 1980, the option of transplantation has become the standard of care for selected patients with end-stage pulmonary parenchymal or pulmonary vascular disorders [1]. Lung transplantation was an option for patients suffering from pulmonary vascular disorders [2] and cystic fibrosis [3]. Most transplantation centers used a local allocation system This strategy is no longer accepted by authorities in most countries worldwide due to its lack of transparency. The Swiss Organ Allocation System (SOAS) for donor lungs is a nationwide, modified chronological system with a defined allocation algorithm and priorities. The Swiss organ allocation system for donor lungs was implemented on 1 July 2007. The effects of this implementation on patient selection, intensive care unit course, outcomes and intensive care costs are unknown
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