Memo To: Thoracic Transplant Clinicians
From: Steven A. Webber, MD, MBChB, MRCP
Chair, Thoracic Organ Transplantation Committee
Recommendation for Submitting Information and Evidence in Support of Lung Review Board (LRB) Exception Requests
Under Policy 184.108.40.206, transplant programs may submit requests to the LRB for “approval of estimated values, diagnosis, or a specific Lung Allocation Score, and in the case of candidates aged 0-11 years old, transplant programs may request classification as an adolescent candidate.” The Thoracic Organ Transplantation Committee offers the following guidance to transplant programs for submitting to the LRB information and evidence in support of exception requests:
- Primary reason for LRB exception request
- Candidate’s diagnosis and demographics, including age, gender, and size
- Candidate’s recent clinical history including hospital admissions, comorbidities, and the clinical course of disease
- Current support, i.e. oxygen supplementation, type and level of ventilatory support, use of ECMO or artificial lung
- Most recent objective evidence of patient deterioration if applicable (e.g. elevation in PaCO2 and/or right atrial pressure, FiO2 requirements, decrease in cardiac index, etc.)
- If candidate has PAH, provide evidence the candidate meets eligibility for LAS exception at the 90th percentile and a description of candidate’s treatment regimen, if applicable
- Explanation of why the candidate should be registered as an adolescent in addition to maintaining pediatric registration, if applicable
The list provided is not exhaustive, but is an example of the important detailed information the LRB will consider before making an informed determination in any LRB case. Applications that are considered inadequate for decision-making will be denied with explanation. Reapplication for LRB exceptions is accepted.
For all requests, OPTN/UNOS Staff will provide the LRB members with a copy of the candidate’s current WaitlistSM record. Transplant programs should ensure that the candidate’s clinical data is up to date in UNetSM.
If you have questions, please email us at LungReviewBoardStaff@unos.org.