The creation of a nationwide organ transplant allocation policy has successfully enabled the sickest patients to receive transplants sooner, a new research paper shows.
The paper shows waiting times dropped from a median of 427 days to 292 days and the odds of being transplanted within six months increased by 41%.
The updated UK Lung Allocation Scheme (UKLAS) was introduced by NHS Blood and Transplant (NHSBT) with advice from an expert advisory group, the Cardiothoracic Advisory Group (Lungs).
The changes to the former scheme included creating new ‘Urgent’ and ‘Super Urgent’ patient categories and replacing the five geographic zones with a nationwide system.
The new paper, published in the BMJ journal ‘Thorax’, covers 471 patients who were registered on to the waiting list between the policy’s introduction in May 2017 and January 2019.
It says: “Shifting from a geographic to a clinical urgency based lung allocation scheme, prioritising the sickest patients, improved odds of transplantation with comparable waiting-list mortality and early post-transplant survival rates.”
The study found people on the super urgent waiting list had a median waiting time of eight days, people on the urgent waiting list had a median waiting time of 15 days, and people on the non-urgent list had a waiting time of 585 days.
More time is needed before a full analysis of longer-term patient outcomes can be carried out. However, there was a reduction in Primary Graft Dysfunction – when the lung takes days or weeks to ‘wake up’ and function properly – which is good indicator that there will be an overall improvement in long term patient outcomes. The incidence of the most severe form of PGD within 72 hours of transplantation reduced significantly, from 25% to 15%.
The overall waiting-list mortality and one-year post-transplant survival rates were similar, indicating the sickest patients were still able to recover from transplants while non-urgent patients were not disadvantaged.
Jasvir Parmar, Transplant Consultant
Jasvir Parmar, Transplant Consultant at Royal Papworth Hospital, is also Chair of the Cardiothoracic Advisory Group (Lungs).
He said: “Creating the urgent categories led to a dramatic reduction on the median waiting times to transplant and, moreover, it did not disadvantage non-urgent registrations, with 30% and 27% of listed patients undergoing lung transplantation within six months of registration, before and after UKLAS introduction, respectively, with no difference in waiting-list deaths.
“The new policy has fulfilled its goals of prioritising the most critically ill and improving the odds of transplantation.
"Although no improvement was seen in waiting-list deaths and the numbers of lung transplants, the true impact of the new scheme is yet to be seen and will likely continue to evolve as transplant teams adjust their practices to harness its full potential.
"COVID-19 significantly reduced lung transplant activity and increased waiting times again but this study shows the difference the new policy makes and how organ donation can save lives.”
Dale Gardiner, NHS Blood and Transplant Associate Medical Director for Deceased Organ Donation, said: “The revised lung allocation scheme was developed to ensure timely allocation of donor lungs to those most in need.
"Geographic boundaries were replaced by a national waiting list prioritised by clinical urgency into super-urgent, urgent and non-urgent tiers.
“We always working to further improve organ allocation policies and we’re pleased to be driving innovation but without donors no transplants would be possible, so we encourage people to confirm their support for organ donation on the NHS Organ Donor Register.”
To find out more about organ donation, and confirm your support for organ donation, visit: www.organdonation.nhs.uk, call 0300 123 23 23 or use the NHS app.