Below is information for lung transplant program physicians, surgeons, transplant coordinators, program directors and data coordinators on the distribution of scores for all lung candidates registered in the U.S. It is intended as a point-in-time reference to help transplant programs understand how their candidates’ scores compare to the national distribution of components of the lung Composite Allocation Score (lung CAS).
Members can also use this information as a guide when submitting CAS exception requests for lung candidates. See the Lung Review Board Operational Guidelines and Clinical Guidance for more information on submitting exception requests.
The guidance includes specific recommendations for lung transplant candidates diagnosed with pulmonary hypertension (PH). Such candidates who meet the following criteria may qualify for an increase in their Waitlist Survival and/or Post-Transplant Outcomes Scores:
- Patient is deteriorating on optimal therapy, and
- Patient has a right atrial pressure greater than 15 mm Hg or a cardiac index less than 1.8 L/min/m2
To request an increase in a PH candidate’s scores, transplant programs must submit an exception request to the Review Board; this request should include sufficient clinical detail to support that the patient meets the above criteria. If the transplant program believes that its patient has similar waiting list mortality and potential transplant benefit as a PH patient meeting the criteria listed above, then it should provide a detailed narrative on that assertion, referencing literature supporting the request for a higher score. Transplant programs may wish to submit to the Review Board exception requests for the candidate’s Waitlist Survival Score and Post-Transplant Outcomes Score to be at the national 90th percentile for each goal (see tables below).
The distribution of Medical Urgency points, Post-transplant Outcomes points, Biological Disadvantages points, CAS subscores for all active registrations waiting for lung transplants as of Sept. 27, 2023 are as follows:
Summary of Medical Urgency Goal Points and Percentage of Goal
| Medical Urgency | Number Waiting | 25th percentile | Median | 75th percentile | 90th percentile | 95th percentile | 99th percentile |
|---|---|---|---|---|---|---|---|
| Number of Points | 963 | 0.1375 | 0.3400 | 0.6950 | 1.4975 | 2.8000 | 12.8825 |
| Percentage of Rating | 963 | 0.5500% | 1.3600% | 2.7800% | 5.9900% | 11.2000% | 51.5300% |
Summary of Post-Transplant Outcomes Goal and Percentage of Goal
| Post-Transplant Outcomes | Number Waiting | 25th percentile | Median | 75th percentile | 90th percentile | 95th percentile | 99th percentile |
|---|---|---|---|---|---|---|---|
| Number of Points | 963 | 18.6336 | 19.5500 | 20.2775 | 20.7975 | 21.0575 | 21.5100 |
| Percentage of Rating | 963 | 74.5344% | 78.2000% | 81.1100% | 83.1900% | 84.2300% | 86.0400% |
Summary of Biological Disadvantages Goal Points and Percentage of Goal
| Biological Disadvantages | Number Waiting | 25th percentile | Median | 75th percentile | 90th percentile | 95th percentile | 99th percentile |
|---|---|---|---|---|---|---|---|
| Number of Points | 963 | 1.4197 | 5.0335 | 5.1935 | 5.5700 | 6.1585 | 8.9140 |
| Percentage of Rating | 963 | 9.4647% | 33.5567% | 34.6233% | 37.1333% | 41.0567% | 59.4267% |
Summary of CAS Subscore
| CAS Subscore | Number Waiting | 25th percentile | Median | 75th percentile | 90th percentile | 95th percentile | 99th percentile |
|---|---|---|---|---|---|---|---|
| Number of Points | 963 | 21.6085 | 24.7045 | 25.8062 | 27.1750 | 30.5382 | 45.8999 |
a Does not include points for efficiency.
Lung continuous distribution
New lung policy took effect March 9, 2023. Resources: UNOS Connect for professional education and the OPTN toolkit for patients and professionals.
