Urgent lung allocation system in the Scandiatransplant countries

Henrik Auråen; Hans Henrik L. Schultz; Pekka Hämmäinen; Gerdt C. Riise; Hillevi Larsson; Lennart Hansson; Göran Dellgren; Michael Perch; Odd Geiran; Arnt E. Fiane; Martin Iversen; Are Martin Holm

doi:10.1016/j.healun.2018.08.002

Urgent lung allocation system in the Scandiatransplant countries

Henrik Auråen, Hans Henrik L. Schultz, Pekka Hämmäinen, Gerdt C. Riise, Hillevi Larsson, Lennart Hansson, Göran Dellgren, Michael Perch, Odd Geiran, Arnt E. Fiane, Martin Iversen, Are Martin Holm^*

^*Corresponding author for this work

Department of Clinical Medicine

8 Citations (Scopus)

Abstract

BACKGROUND: Throughout the world, the scarcity of donor organs makes optimal allocation systems necessary. In the Scandiatransplant countries, organs for lung transplantation are allocated nationally. To ensure shorter wait time for critically ill patients, the Scandiatransplant urgent lung allocation system (ScULAS) was introduced in 2009, giving supranational priority to patients considered urgent. There were no pre-defined criteria for listing a patient as urgent, but each center was granted only 3 urgent calls per year. This study aims to explore the characteristics and outcome of patients listed as urgent, assess changes associated with the implementation of ScULAS, and describe how the system was utilized by the member centers. METHODS: All patients listed for lung transplantation at the 5 Scandiatransplant centers 5 years before and after implementation of ScULAS were included. RESULTS: After implementation, 8.3% of all listed patients received urgent status, of whom 81% were transplanted within 4 weeks. Patients listed as urgent were younger, more commonly had suppurative lung disease, and were more often on life support compared with patients without urgent status. For patients listed as urgent, post-transplant graft survival was inferior at 30 and 90 days. Although there were no pre-defined criteria for urgent listing, the system was not utilized at its maximum. CONCLUSIONS: ScULAS rapidly allocated organs to patients considered urgent. These patients were younger and more often had suppurative lung disease. Patients with urgent status had inferior short-term outcome, plausibly due to the higher proportion on life support before transplantation.

Original language	English
Journal	Journal of Heart and Lung Transplantation
Volume	37
Issue number	12
Pages (from-to)	1403-1409
Number of pages	7
ISSN	1053-2498
DOIs	https://doi.org/10.1016/j.healun.2018.08.002
Publication status	Published - 2018

Keywords

allocation
lung
scandiatransplant
transplantation
urgency

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10.1016/j.healun.2018.08.002

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@article{715b0fb4e416420eb659df6630753b96,

title = "Urgent lung allocation system in the Scandiatransplant countries",

abstract = "BACKGROUND: Throughout the world, the scarcity of donor organs makes optimal allocation systems necessary. In the Scandiatransplant countries, organs for lung transplantation are allocated nationally. To ensure shorter wait time for critically ill patients, the Scandiatransplant urgent lung allocation system (ScULAS) was introduced in 2009, giving supranational priority to patients considered urgent. There were no pre-defined criteria for listing a patient as urgent, but each center was granted only 3 urgent calls per year. This study aims to explore the characteristics and outcome of patients listed as urgent, assess changes associated with the implementation of ScULAS, and describe how the system was utilized by the member centers. METHODS: All patients listed for lung transplantation at the 5 Scandiatransplant centers 5 years before and after implementation of ScULAS were included. RESULTS: After implementation, 8.3% of all listed patients received urgent status, of whom 81% were transplanted within 4 weeks. Patients listed as urgent were younger, more commonly had suppurative lung disease, and were more often on life support compared with patients without urgent status. For patients listed as urgent, post-transplant graft survival was inferior at 30 and 90 days. Although there were no pre-defined criteria for urgent listing, the system was not utilized at its maximum. CONCLUSIONS: ScULAS rapidly allocated organs to patients considered urgent. These patients were younger and more often had suppurative lung disease. Patients with urgent status had inferior short-term outcome, plausibly due to the higher proportion on life support before transplantation.",

keywords = "allocation, lung, scandiatransplant, transplantation, urgency",

author = "Henrik Aur{\aa}en and Schultz, {Hans Henrik L.} and Pekka H{\"a}mm{\"a}inen and Riise, {Gerdt C.} and Hillevi Larsson and Lennart Hansson and G{\"o}ran Dellgren and Michael Perch and Odd Geiran and Fiane, {Arnt E.} and Martin Iversen and Holm, {Are Martin}",

year = "2018",

doi = "10.1016/j.healun.2018.08.002",

language = "English",

volume = "37",

pages = "1403--1409",

journal = "Journal of Heart and Lung Transplantation",

issn = "1053-2498",

publisher = "Elsevier",

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TY - JOUR

T1 - Urgent lung allocation system in the Scandiatransplant countries

AU - Auråen, Henrik

AU - Schultz, Hans Henrik L.

AU - Hämmäinen, Pekka

AU - Riise, Gerdt C.

AU - Larsson, Hillevi

AU - Hansson, Lennart

AU - Dellgren, Göran

AU - Perch, Michael

AU - Geiran, Odd

AU - Fiane, Arnt E.

AU - Iversen, Martin

AU - Holm, Are Martin

PY - 2018

Y1 - 2018

N2 - BACKGROUND: Throughout the world, the scarcity of donor organs makes optimal allocation systems necessary. In the Scandiatransplant countries, organs for lung transplantation are allocated nationally. To ensure shorter wait time for critically ill patients, the Scandiatransplant urgent lung allocation system (ScULAS) was introduced in 2009, giving supranational priority to patients considered urgent. There were no pre-defined criteria for listing a patient as urgent, but each center was granted only 3 urgent calls per year. This study aims to explore the characteristics and outcome of patients listed as urgent, assess changes associated with the implementation of ScULAS, and describe how the system was utilized by the member centers. METHODS: All patients listed for lung transplantation at the 5 Scandiatransplant centers 5 years before and after implementation of ScULAS were included. RESULTS: After implementation, 8.3% of all listed patients received urgent status, of whom 81% were transplanted within 4 weeks. Patients listed as urgent were younger, more commonly had suppurative lung disease, and were more often on life support compared with patients without urgent status. For patients listed as urgent, post-transplant graft survival was inferior at 30 and 90 days. Although there were no pre-defined criteria for urgent listing, the system was not utilized at its maximum. CONCLUSIONS: ScULAS rapidly allocated organs to patients considered urgent. These patients were younger and more often had suppurative lung disease. Patients with urgent status had inferior short-term outcome, plausibly due to the higher proportion on life support before transplantation.

AB - BACKGROUND: Throughout the world, the scarcity of donor organs makes optimal allocation systems necessary. In the Scandiatransplant countries, organs for lung transplantation are allocated nationally. To ensure shorter wait time for critically ill patients, the Scandiatransplant urgent lung allocation system (ScULAS) was introduced in 2009, giving supranational priority to patients considered urgent. There were no pre-defined criteria for listing a patient as urgent, but each center was granted only 3 urgent calls per year. This study aims to explore the characteristics and outcome of patients listed as urgent, assess changes associated with the implementation of ScULAS, and describe how the system was utilized by the member centers. METHODS: All patients listed for lung transplantation at the 5 Scandiatransplant centers 5 years before and after implementation of ScULAS were included. RESULTS: After implementation, 8.3% of all listed patients received urgent status, of whom 81% were transplanted within 4 weeks. Patients listed as urgent were younger, more commonly had suppurative lung disease, and were more often on life support compared with patients without urgent status. For patients listed as urgent, post-transplant graft survival was inferior at 30 and 90 days. Although there were no pre-defined criteria for urgent listing, the system was not utilized at its maximum. CONCLUSIONS: ScULAS rapidly allocated organs to patients considered urgent. These patients were younger and more often had suppurative lung disease. Patients with urgent status had inferior short-term outcome, plausibly due to the higher proportion on life support before transplantation.

KW - allocation

KW - lung

KW - scandiatransplant

KW - transplantation

KW - urgency

U2 - 10.1016/j.healun.2018.08.002

DO - 10.1016/j.healun.2018.08.002

M3 - Journal article

C2 - 30241891

AN - SCOPUS:85053727736

SN - 1053-2498

VL - 37

SP - 1403

EP - 1409

JO - Journal of Heart and Lung Transplantation

JF - Journal of Heart and Lung Transplantation

IS - 12

ER -

Urgent lung allocation system in the Scandiatransplant countries

Abstract

Keywords

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