Perspectives on donor lung allocation from both sides of the Atlantic: The United States.
Perspectives on donor lung allocation from both sides of the Atlantic: The United States.
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DOI：
10.1111/ctr.13873
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发表时间：
2020-07
影响因子：
2.1
通讯作者：
Budev MM
中科院分区：
文献类型：
--
作者：
Tsuang WM;Snyder LD;Budev MM
美国的供体肺分配侧重于降低等待名单死亡率和改善受者结局。通过政府和私营组织之间独特的伙伴关系，即卫生和公众服务部下属的器官采购和移植网络和器官共享联合网络，实施分配政策，将已故捐赠者的肺与等候名单上的患者相匹配。2005年，供体肺分配算法转向优先考虑等待名单上的患者的医疗紧急情况，而不是等待名单上累积的时间。这导致了肺分配评分，它权衡了十几个临床变量，以预测一年的生存益处估计，并被用来对等待名单上的患者进行优先排序。2017年，取消了使用当地分配边界，转而将距捐赠医院250海里半径作为分配中使用的第一个距离单位。捐助者分配政策的下一次迭代预计将使用一种连续分配算法，其中消除了所有地理边界。还有更多的机会来改善供体肺的分配，例如对于抗体滴度高的患者，可以接触到有限数量的捐赠者。
Donor lung allocation in the United States focuses on decreasing waitlist mortality and improving recipient outcomes. The implementation of allocation policy to match deceased donor lungs to waitlisted patients occurs through a unique partnership between government and private organizations, namely the Organ Procurement and Transplantation Network under the Department of Health and Human Services and the United Network for Organ Sharing. In 2005, the donor lung allocation algorithm shifted towards the prioritization of medical urgency of waitlisted patients instead of time accrued on the waitlist. This led to the Lung Allocation Score, which weighs over a dozen clinical variables to predict a one-year estimate of survival benefit, and is used to prioritize waitlisted patients. In 2017 the use of local allocation boundaries was eliminated in favor of a 250 nautical mile radius from the donor hospital as the first unit of distance used in allocation. The next upcoming iteration of donor allocation policy is expected to use a continuous distribution algorithm where all geographic boundaries are eliminated. There are additional opportunities to improve donor lung allocation, such as for patients with high antibody titers with access to a limited number of donors..
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