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.
Recommendations for lung transplant candidates diagnosed with pulmonary hypertension (PH)
- 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 April 22, 2024 are as follows:
Please note: When submitting an exception request for one of the attributes, when prompted to enter the requested percentage of goal:
- You first need to identify the percentile column that you are requesting in the corresponding table above
- Then enter the value in the Percentage of Rating row that corresponds with that percentile
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 | 953 | 0.1175 | 0.3400 | 0.6800 | 1.2825 | 1.8050 | 12.1650 |
| Percentage of Rating | 953 | 0.4700% | 1.3600% | 2.7200% | 5.1300% | 7.2200% | 48.6600% |
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 | 953 | 18.5650 | 19.4700 | 20.2500 | 20.7825 | 21.2350 | 21.7700 |
| Percentage of Rating | 953 | 74.2600% | 77.8800% | 81.0000% | 83.1300% | 84.9400% | 87.0800% |
Summary of Biological Disadvantages Goal Points and Percentage of Goal
| Biological Disadvantages | Blood Type | Number Waiting | 25th percentile | Median | 75th percentile | 90th percentile | 95th percentile | 99th percentile |
|---|---|---|---|---|---|---|---|---|
| Number of Points | All Candidates | 953 | 0.7497 | 5.0245 | 5.1795 | 5.5450 | 6.1345 | 7.9965 |
| Percentage of Rating | All Candidates | 953 | 4.9980% | 33.4967% | 34.5300% | 36.9667% | 40.8967% | 53.3100% |
| Number of Points | O | 562 | 5.0335 | 5.1095 | 5.2935 | 5.9320 | 6.5650 | 9.2250 |
| Percentage of Rating | O | 562 | 33.5567% | 34.0633% | 35.2900% | 39.5467% | 43.7667% | 61.5000% |
| Number of Points | A | 303 | 0.3392 | 0.4117 | 0.7002 | 1.7892 | 4.5807 | 5.5450 |
| Percentage of Rating | A | 303 | 2.2613% | 2.7447% | 4.6680% | 11.9280% | 30.5380% | 36.9667% |
| Number of Points | B | 81 | 2.2672 | 2.3197 | 2.6727 | 4.4607 | 6.8257 | 7.1622 |
| Percentage of Rating | B | 81 | 15.1147% | 15.4647% | 17.8180% | 29.7380% | 45.5047% | 47.7480% |
| Number of Points | AB | 7 | 0.0335 | 0.2455 | 0.5615 | 1.2555 | 5.0555 | 5.0555 |
| Percentage of Rating | AB | 7 | 0.2233% | 1.6367% | 3.7433% | 8.3700% | 33.7033% | 33.7033% |
Summary of CAS Subscore
| Blood Type | Number Waiting | 25th percentile | Median | 75th percentile | 90th percentile | 95th percentile | 99th percentile |
|---|---|---|---|---|---|---|---|
| All Candidates | 953 | 21.2767 | 24.2730 | 25.6435 | 26.8945 | 28.7445 | 45.7681 |
| O | 562 | 24.3110 | 25.2515 | 26.0085 | 27.1020 | 28.1885 | 41.5375 |
| A | 303 | 19.7492 | 20.6132 | 21.4942 | 23.6872 | 36.0247 | 44.3014 |
| B | 81 | 21.8337 | 22.8517 | 23.7172 | 26.8572 | 31.8712 | 47.3666 |
| AB | 7 | 17.9925 | 20.7610 | 21.0890 | 26.1930 | 31.1555 | 31.1555 |
a Does not include points for efficiency.
