We are providing this information to all lung transplant physicians, lung transplant surgeons, lung transplant coordinators, UNetSM Site Administrators, transplant program directors, and data coordinators at lung and heart/lung transplant programs. Please share this notice with anyone in your organization who would benefit from this information.
Submitting Lung Allocation Score Exception Requests for Candidates Diagnosed with Pulmonary Hypertension
Lung transplant candidates diagnosed with pulmonary hypertension (PH) and who meet the following criteria may qualify for an increase in their Lung Allocation Score (LAS):
- Patient is deteriorating on optimal therapy, and
- Patient has a right atrial pressure greater than 15 mm Hg ora cardiac index less than 1.8 L/min/m2.
To request an increase in a PH candidate’s LAS, transplant programs must submit an exception request to the Lung Review Board (LRB); 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 LAS. When submitting an exception request, transplant programs must provide a clinical justification for the exception. Please refer to Policy 10.2.B (Lung Candidates with Exceptional Cases) for additional information about the exception review process.
Policy 10.2.B allows a transplant program to submit an exception request for an LAS, an estimated value for one of the tests that is used to calculate the LAS, or assignment to a diagnosis group for a disease that is not listed in WaitlistSM.
Note: The LRB will render clinical judgment on exception requests for higher LAS, diagnosis, or estimated value.
Transplant programs may wish to submit to the LRB an exception request for the candidate’s LAS to be at the national 90th percentile (see table below).
The LAS for all active candidates greater than or equal to 12 years of age waiting for lung transplants as of Jan. 22, 2021 are as follows:
|Number waiting||25th percentile||Median||75th percentile||90th percentile||95th percentile||99th percentile|