Examining equity in access to deceased donor lung transplants

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)