Balancing fairness and efficacy in lung allocation for transplantation: unfinished business

Meyer, Keith C.

doi:10.1136/thoraxjnl-2018-212634

Cited by 2 publications

(2 citation statements)

References 14 publications

(9 reference statements)

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“…As is often the case in therapeutic endeavours where resource limitation (in this case donor availability) is a major factor, the clinical balance is how best to achieve the optimum result for the largest number of potential recipients. 46 The LAS works to maximize survival benefit but does not address modality specifically. Once the dominant form of LTx, heart-lung transplantation (HLTx) is now virtually reserved for congenital heart disease (CHD) refractory to medical and 6 journals.sagepub.com/home/tar surgical therapies and, in truth, is now rarely performed outside major high-volume centres.…”

Section: Which Transplant Modality?mentioning

confidence: 99%

“…If the stated aim of LTx is to prolong life and improve quality of life of patients afflicted with terminal lung disorders, decisions regarding resource utilization must balance the needs of the individual patient with the needs of the community. 46 This ethical dilemma underscores many of the discussions regarding the use of SLTx versus BSSLTx, the use of extended criteria donors and recipient age criteria as well as the vexed question of retransplantation. 52 At extremes of age in particular, and, given the ravages of chronic diseases, it is important to consider actuarial survival as a factor when making decisions regarding suitability, allowing that ageism should not dictate behaviour.…”

Section: Resource Allocationmentioning

confidence: 99%

See 1 more Smart Citation

Lung transplantation: a review of the optimal strategies for referral and patient selection

Mitchell

Glanville

2019

Ther Adv Respir Dis

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One of the great challenges of lung transplantation is to bridge the dichotomy between supply and demand of donor organs so that the maximum number of potential recipients achieve a meaningful benefit in improvements in survival and quality of life. To achieve this laudable goal is predicated on choosing candidates who are sufficiently unwell, in fact possessing a terminal respiratory illness, but otherwise fit and able to undergo major surgery and a prolonged recuperation and rehabilitation stage combined with ongoing adherence to complex medical therapies. The choice of potential candidate and the timing of that referral is at times perhaps more art than science, but there are a number of solid guidelines for specific illnesses to assist the interested clinician. In this regard, the relationship between the referring clinician and the lung transplant unit is a critical one. It is an ongoing and dynamic process of education and two way communication, which is a marker of the professionalism of a highly performing unit. Lung transplantation is ultimately a team effort where the recipient is the key player. That principle has been enshrined in the three consensus position statements regarding selection criteria for lung and heart-lung transplantation promulgated by the International Society for Heart and Lung Transplantation over the last two decades. During this period, the number of indications for lung transplantation have broadened and the number of contraindications reduced. Risk management is paramount in the pre- and perioperative period to effect early successful outcomes. While it is not the province of this review to reiterate the detailed listing of those factors, an overview position will be developed that describes the rationale and evidence for selected criteria where that exists. Importantly, the authors will attempt to provide an historical and experiential basis for making these important and life-determining decisions. The reviews of this paper are available via the supplementary material section.

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Section: Which Transplant Modality?mentioning

confidence: 99%

Section: Resource Allocationmentioning

confidence: 99%