Modify pediatric lung policy

Proposal Overview

Status: Implemented

Sponsoring Committee: Thoracic Organ Transplantation

Strategic Goal: Provide equity in access to transplants

Effective date: 3/30/2017

Policy notice (1/2016)

On May 31, 2013, former Secretary of Health and Human Services, Kathleen Sebelius, requested that the OPTN review lung allocation policy, with “particular attention to the age categories used in allocation” and the “intent of identifying any potential improvements to this policy that would make more transplants available to children, consistent with the requirements of the OPTN final rule.” As an immediate measure, the OPTN/UNOS Board of Directors approved the Adolescent Classification Exception for Pediatric Candidates, which allowed lung candidates less than 12 years old to request an exception from the Lung Review Board to be classified as an adolescent candidate for the purposes of prioritization by Lung Allocation Score (LAS). Following its passage, the Thoracic Organ Transplantation Committee conducted a more comprehensive review of lung allocation policy and identified two additional opportunities for improving access to transplant for all pediatric candidates less than 18 years old.

The Committee proposes broader geographic sharing of pediatric donor lungs. This will give candidates less than 18 years old better access to properly sized donors, which aligns with Goal 2 of the OPTN Strategic Plan. The Committee also proposes establishing eligibility criteria for candidates registered prior to their second birthday to receive a deceased donor lung of any blood type. This will increase utilization of the smallest donor lungs and decrease waiting list mortality among infants, which supports Goals 1 and 3 of the OPTN Strategic Plan.

This proposal was available for public comment in August 2015.

Read the full proposal (PDF)

In December 2015, the OPTN/UNOS Board of Directors approved policy changes establishing criteria for intended blood type incompatible matching for pediatric lung candidates registered before two-years old as well as broader sharing for pediatric lungs. The policy allows candidates registered before turning two-years old, to receive lungs from a donor with an incompatible blood type, if they meet eligibility requirements stated in policy.

Pediatric lung policy and system changes implemented on 3/30/2017

Audience:

UNet^SM users who enter data for pediatric lung candidates
All OPO staff who use UNet

We revised the lung allocation algorithm and retired the Adolescent Donor Lung Allocation (12-17 years of age). The following two allocations are now in effect:

Pediatric Donor Lung Allocation (lung donors less than 18 years old)
Adult Donor Lung Allocation (donors 18 years or older)

Note: Approved policy denotes the changes specific to pediatric lung policy, but programming applies to lung and heart-lung candidates.

What changed in the Waitlist application?
If you register your candidate as willing to receive an intended blood type incompatible offer, your program will need to submit additional titer data. We added new fields to the lung and heart-lung candidate records to capture the new eligibility requirements.

The eligibility requirements for candidates to receive incompatible lung offers differ depending on their age.

1. Less than one-year-old when the match is run:

Candidate must be priority 1
Transplant program must have submitted isohemagglutinin titer information for A or B blood type antigens through UNet within the last 30 days.

2. At least one-year-old when the match is run and was registered in Waitlist before turning two:

Candidate must be priority 1
Transplant program must have submitted through UNet isohemagglutinin titers less than or equal to 1:16 for A or B blood type antigens from a blood sample they collected within the last 30 days. The candidate must not have received treatments that may have reduced isohemagglutinin titers to 1:16 or less within 30 days of when the blood sample was collected.

Note: For heart-lung candidates, the candidate must be a status 1A/1B for heart and priority 1 for lung.