Broader Geographic Sharing of Pediatric Donor Lungs Improves Pediatric Access to Transplant

Abstract

US pediatric transplant candidates have limited access to lung transplant due to the small number of donors within current geographic boundaries, leading to assertions that the current lung allocation system does not adequately serve pediatric patients. We hypothesized that broader geographic sharing of pediatric (adolescent, 12â 17 years; child, <12 years) donor lungs would increase pediatric candidate access to transplant. We used the thoracic simulated allocation model to simulate broader geographic sharing. Simulation 1 used current allocation rules. Simulation 2 offered adolescent donor lungs across a wider geographic area to adolescents. Simulation 3 offered child donor lungs across a wider geographic area to adolescents. Simulation 4 combined simulations 2 and 3. Simulation 5 prioritized adolescent donor lungs to children across a wider geographic area. Simulation 4 resulted in 461 adolescent transplants per 100 patientâ years on the waiting list (range 417â 542), compared with 206 (range 180â 228) under current rules. Simulation 5 resulted in 388 adolescent transplants per 100 patientâ years on the waiting list (range 348â 418) and likely increased transplant rates for children. Adult transplant rates, waitlist mortality, and 1â year posttransplant mortality were not adversely affected. Broader geographic sharing of pediatric donor lungs may increase pediatric candidate access to lung transplant.This study addresses the problem of US pediatric transplant candidatesâ limited access to lung transplants and shows that broader geographic sharing of pediatric donor lungs can increase pediatric transplant rates without adversely impacting adult patients.