Table 3 History and development of lung allocation
Name | Contributing Author(s) | Year of Publication | Year of Adoption by UNOS | Objective | Included Criteria | Changes to Criteria | Range of Scores | Calculation |
|---|---|---|---|---|---|---|---|---|
N/A | N/A | Unknown | Unknown | Balance postoperative survival and risk of death without transplant | Time accrued on the waitlist | N/A | N/A | N/A |
N/A | UNOS | N/A | 1995 | Balance postoperative survival and risk of death without transplant | Time accrued on the waitlist, idiopathic pulmonary fibrosis (IPF) status | + IPF status | 90 days were added to patients on the waitlist who had IPF | N/A |
Lung Allocation Score | UNOS Thoracic Organ Transplantation Committee Lung Allocation Subcommittee | Unknown | 2005 | Balance postoperative survival and risk of death without transplant | Age, assisted ventilation requirement, serum, bilirubin and creatinine, body mass index, cardiac index before exercise, central venous pressure, mechanical ventilation status, diabetes status, diagnosis, forced vital capacity, functional status, oxygen requirement at rest, pulmonary artery pressure, 6-min walk test distance | *All variables are added compared to the previous model. Variables in the previous model no longer exist in this version | The waitlist and post-transplant area under the curve are mapped. Transplant benefit is calculated as the difference between post-transplant and waitlist survival. The normalized LAS score ranges from 0 to 100. | Raw LAS = posttransplant survival − 2 x (waitlist urgency measure). Normalized LAS = 100 x [raw LAS x (2 × 365)]/(3 × 365). |
Composite Allocation Score | OPTN ad hoc Committee on Geography | 2019 | 2023 | Balance postoperative survival and risk of death without transplant | Waitlist survival (5-year WLAUC), post-transplant survival (5-year PTAUC), biological disadvantages (blood type, CPRA, height), patient access (prior living donation, pediatric status), placement efficiency (travel cost and proximity) | + length of WTAUC and PTAUC assessments (1 year vs. 5 years) + prior living donation status + pediatric status | From 0 to 100 | CAS = 0.25 x waitlist survival + 0.25 x post-transplant survival + 0.15 x biological disadvantages + 0.25 x patient access + 0.1 x placement efficiency |