Examining equity in access to deceased donor lung transplants

photos of UNOS researchers who presented at ATC

Recently published study measured disparities related to geographic, demographic, clinical and socioeconomic factors for lung allocation.

in focus

Donation service area was found to be the factor most independently associated with disparities in access to transplant.

Variability in access-to-transplant scores (ATS) among waitlisted lung candidates (10/01/2019 - 03/31/2020)

Donation service area, or DSA, was the factor most independently associated with health disparities in access to lung transplant between 2010 and 2019, according to Rebecca Goff, Ph.D., the lead author in a United Network for Organ Sharing led-study that was presented at the 2020 American Transplant Congress in May.

In 2018, the Organ Procurement and Transplantation Network published an approach to measure equity in access to deceased donor kidney transplantation. Following that publication in 2019, the same approach was applied to lung allocation. During that time period, three major modifications were made to policies that influence lung allocation in the U.S., including the removal of DSA. Despite the policy modifications, the researchers found that disparities related to geographic, demographic, clinical, and socioeconomic factors during the time period remained very stable.

After accounting for factors used in lung allocation policy, such as lung allocation score, pediatric priority, and blood type compatibility, the study sought to determine how access to transplant was impacted by factors, like:

Age
Race/ethnicity
Education
Blood type
Diagnosis group
Insurance type
DSA

Deceased donor transplant rate regression models were tracked over time. Even after removing DSA as a unit of allocation for lung in 2017, it was the factor that contributed most to inequities. Other factors that rose to the top, but were well below DSA, included:

Gender
Ethnicity
Diagnosis group
Age

The researchers plan to use the same methodology to monitor the impact on equity of future policy changes, such as the anticipated transition to continuous distribution for lungs.

Check out the OPTN’s Equity in Access to Transplant Dashboard, an online tool that identifies factors most associated with disparities in access to kidney, liver and lung transplants.

Read the abstract

Goff RR, Lease ED, Sweet S, Robinson A, Stewart D. Measuring and Monitoring Equity in Access to Deceased Donor Lung Transplants among Lung Registrations [abstract]. Am J Transplant. 2020; 20 (suppl 3)