Understanding the lung allocation score for the non-transplant pulmonologist

Abstract

In order to better allocate scarce donor lung organs, the lung allocation score (LAS) was implemented in May 2005. The goals of the LAS were to reduce waiting list mortality of lung transplant candidates, to prioritize candidates based on medical urgency, and to maximize overall lung transplant benefit. Pre-transplant candidate variables are used to calculate waiting list survival, post-transplant survival, and transplant benefit measures. These measures produce a numerical lung allocation score between 0 and 100 with a higher score recipient receiving a greater priority ranking for donor lungs. LAS implementation improved candidate waiting list time and prioritized patients with the greatest medical urgency. However, waiting list mortality has not improved and further revisions to predicting variables have been implemented to better reflect the current transplant candidate population. One-year post-transplant survival in the post-LAS era has not changed compared to that in the pre-LAS era.