P168. Demographics and Impact of Organ Procurement Organization-Initiated Out of Sequence Offers for Donor Lungs
Presented During: Thoracic Poster Session II
Duke University Medical Center
Durham, NC
United States - Contact Me
Kunal Patel is an Assistant Professor of Surgery at Duke University where he serves on faculty in both general thoracic and lung transplant surgery. He has a PhD in Transplant Immunology and his research interests focus on innate immune mechanisms of transplant rejection and complement dysregulation.
Sunday, May 4, 2025: 9:00 AM - 4:00 PM
Seattle Convention Center | Summit
Room: Poster Area, Exhibit Hall
Description
Objective: To evaluate the role of out of sequence (OOS) offers (aka open offers) on donor lung allocation, and assess the association of the new lung composite allocation score (CAS) system with out of sequence offers.
Methods: A retrospective review was conducted of the UNOS Potential Transplant Recipient dataset spanning from January 2006 to March 2024. Match run data on allocation of organs for adult (18+) lung transplant (LTx) recipients was analyzed. Only organs that were ultimately transplanted were analyzed and multiorgan recipients were excluded.
Results: Between 2006 and 2024, we identified 36,229 donor lungs allocated through the standard sequence and 1,550 donor lungs allocated via exception (i.e., OOS). Lungs placed OOS demonstrated male predominance (994[64.1%] vs 21,790[60.1%]), increased use of cigarettes >20 pack-years (166[10.7%] vs 3,125[8.6%]), and were more likely DCD donors (102[6.6%] vs 1,637[4.5%]). OOS organs were less likely to have a documented pulmonary infection (918[59.2%] vs 22,545[62.2%]). Blood type A and B were less likely to be allocated OOS, whereas type O was more likely (1,001[64.6%] vs 18,454[51.2%]). Donor age and cause of death were not significantly different. Recipients of OOS lung offers tended to be older (64 vs 60), white race (1,298[84.1%] vs 28,497[78.7%]), and undergoing single LTx (781[50.4%] vs 9,531[26.3%]). Overall, OOS recipients demonstrated lower average LAS and CAS scores, lower rates of LTx from inpatient (ICU and general ward), and lower ventilator and ECMO bridge rates. Recipients were more likely to have obstructive lung disease. Geographic distribution of OOS offers demonstrates regional variations (Figure 1). The overall rates of OOS lung offers demonstrated a decline from 2006 to 2008 after the implementation of LAS. Since 2023, when LAS was replaced by CAS, there has been a rise in OOS offer rates from 4% to 10%.
Conclusions: The rate of OOS lung offers demonstrates variability correlated to changes in the allocation systems, and is perhaps an unintended consequence of the new CAS system. Overall, single LTx appears to require OOS offers most commonly, despite these lungs not generally meeting extended criteria. Generally, the accepting centers appear to be utilizing these organs for patients prioritized lower in the CAS who may be experiencing inordinately long wait times. These findings may represent opportunities to optimize lung allocation and the new CAS system.
Authors
Kunal Patel (1), Oliver Jawitz (2), Ahmed Gurses (1), Jacob Klapper (2), Matthew Hartwig (3)
Institutions
(1) Duke University Medical Center, Durham, NC, (2) Duke University Hospital, Durham, NC, (3) Duke Hospital, Durham, NC
Methods: A retrospective review was conducted of the UNOS Potential Transplant Recipient dataset spanning from January 2006 to March 2024. Match run data on allocation of organs for adult (18+) lung transplant (LTx) recipients was analyzed. Only organs that were ultimately transplanted were analyzed and multiorgan recipients were excluded.
Results: Between 2006 and 2024, we identified 36,229 donor lungs allocated through the standard sequence and 1,550 donor lungs allocated via exception (i.e., OOS). Lungs placed OOS demonstrated male predominance (994[64.1%] vs 21,790[60.1%]), increased use of cigarettes >20 pack-years (166[10.7%] vs 3,125[8.6%]), and were more likely DCD donors (102[6.6%] vs 1,637[4.5%]). OOS organs were less likely to have a documented pulmonary infection (918[59.2%] vs 22,545[62.2%]). Blood type A and B were less likely to be allocated OOS, whereas type O was more likely (1,001[64.6%] vs 18,454[51.2%]). Donor age and cause of death were not significantly different. Recipients of OOS lung offers tended to be older (64 vs 60), white race (1,298[84.1%] vs 28,497[78.7%]), and undergoing single LTx (781[50.4%] vs 9,531[26.3%]). Overall, OOS recipients demonstrated lower average LAS and CAS scores, lower rates of LTx from inpatient (ICU and general ward), and lower ventilator and ECMO bridge rates. Recipients were more likely to have obstructive lung disease. Geographic distribution of OOS offers demonstrates regional variations (Figure 1). The overall rates of OOS lung offers demonstrated a decline from 2006 to 2008 after the implementation of LAS. Since 2023, when LAS was replaced by CAS, there has been a rise in OOS offer rates from 4% to 10%.
Conclusions: The rate of OOS lung offers demonstrates variability correlated to changes in the allocation systems, and is perhaps an unintended consequence of the new CAS system. Overall, single LTx appears to require OOS offers most commonly, despite these lungs not generally meeting extended criteria. Generally, the accepting centers appear to be utilizing these organs for patients prioritized lower in the CAS who may be experiencing inordinately long wait times. These findings may represent opportunities to optimize lung allocation and the new CAS system.
Authors
Kunal Patel (1), Oliver Jawitz (2), Ahmed Gurses (1), Jacob Klapper (2), Matthew Hartwig (3)
Institutions
(1) Duke University Medical Center, Durham, NC, (2) Duke University Hospital, Durham, NC, (3) Duke Hospital, Durham, NC