Clinical lung and heart/lung transplantationLung allocation in the United States, 1995–1997: an analysis of equity and utility
Section snippets
Materials and methods
All lung transplantation registrations (listings), deaths while waiting, and transplant procedures performed in the United States between January 1, 1995 and December 31, 1997 and reported to UNOS were analyzed.
Eighty-one lung-transplant centers were active during this time period. The average number of lung transplants performed (activity) during the 3 years of the study was used to categorize lung-transplant centers. Centers were considered small if they performed ≤£ 10 transplants/year (n =
Results
Figure 1 displays the number of new patient registrations for lung transplantation in the United States during the 3-year time period 1995–1997, by center size. The number of patients newly listed at medium-sized programs has grown slightly, whereas the number of new registrations has remained fairly constant at small and large programs. Approximately half of all newly registered candidates are listed at medium-sized transplant centers.
Between 1995 and 1997, 22% (550/2529) of all lung
Discussion
Disparity in waiting times among transplant centers was one of the predominant factors motivating the DHHS initiative to revamp the U.S. transplant-allocation system. Our data confirm the perception that large lung-transplant programs have longer wait times than medium- and small-size programs. We next asked whether longer wait time at large programs translated into higher risk of death while waiting. We found that for lung transplantation, when adjusted for years at risk, candidates at small-
Acknowledgements
This study was funded in part by the U.S. Department of Health and Human Services, Health Resources and Services Administration, Office of Special Programs, Division of Transplantation, under contract numbers 240-97-0001 and 240-97-0002, for the operation of the Organ Procurement and Transplantation Network and the U.S. Scientific Registry of Transplant Recipients.
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