Distribution of donor lungs in the United States: a case for broader geographic sharing

To evaluate the association between allocation of donor lungs by geographic sharing type (GST) and lung allocation score (LAS).UNOS data included lung transplant recipients between 5/4/05 and 09/30/15 (n = 17 416) grouped by GST of donor lungs: local, regional, or national. Recipients were stratified by LAS50, 50-75, and75. Kaplan-Meier analysis was used to assess five-yr survival.The majority of lungs were shared locally (n = 9200; 52.8%) followed by nationally (n = 5356; 30.8%) and regionally (n = 2860; 16.4%). There was a significant difference in the mean LAS at transplant (local: 43.7 ± 15; regional: 49.5 ± 18.8; national 51 ± 19.4; p0.001). There was a significant association between GST and LAS (p0.001). The majority (n = 7431; 58.2%) of recipients with LAS50 received local lungs. Recipients with LAS75 received a majority of their organs from national (n = 881; 45.4%) and regional (n = 414; 21.6%) donors. Although statistically significant (p = 0.024), absolute decline in five-yr survival by GST in the national GST was only 1.1% compared to the local GST.Nearly half of all lungs in the United States are allocated locally to recipients with an LAS50. Additional studies should determine if organ sharing over broader geographies would improve waitlist outcomes.