Leveraging Machine Perfusion to Ameliorate Geographic Disparities in Organ Allocation

Derek Soled,Cray Noah

doi:10.52214/vib.v7i.8219

Abstract

Leveraging Machine Perfusion to Ameliorate Geographic Disparities in Organ Allocation

Highlights

Geographic inequities in access to donor lungs have persisted since the first successful lung transplant in 1983. 1 With unanswered questions regarding organ preservation and transport in the early days of transplantation, the United Network of Organ Sharing (UNOS) understandably incorporated geography in the allocation algorithm
While much of the attention around machine perfusion has been about its capability to resuscitate marginal organs, its secondary ability, allowing farther transport of lungs, could end geographic disparities in organ allocation
Before it is universally adopted into clinical practice, it is imperative that UNOS acts to direct hospitals on how to integrate machine perfusion into procurement networks

Summary

INTRODUCTION

Geographic inequities in access to donor lungs have persisted since the first successful lung transplant in 1983. 1 With unanswered questions regarding organ preservation and transport in the early days of transplantation, the United Network of Organ Sharing (UNOS) understandably incorporated geography in the allocation algorithm. In 1998, after physician protest and advocacy, the U.S Department of Health and Human Services (HHS) delivered the Final Rule on Organ Transplantation to create a more equitable organ allocation system. Even it was not until 2005 that UNOS developed the lung allocation score, a quantitative metric that. The implementation of the lung allocation score in the U.S and abroad by Eurotransplant was a success by multiple standards, most importantly reducing waitlist mortality to record lows.[3] a glaring problem remained: the donor service area criterion remained, and arbitrary geographical boundaries continued to govern the distribution of all procured lungs. Analysis of data over the last decade shows that donor service areas are independently associated with disparities in access to lung transplants significantly more than any other factor, including gender, ethnicity, diagnosis group, or age

The Future

Findings

CONCLUSION