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Balancing fairness and efficacy in lung allocation for transplantation: unfinished business
  1. Keith C Meyer
  1. Correspondence to Dr Keith C Meyer, University of Wisconsin Lung Transplant and Advanced Lung Disease Program, Section of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 53726, USA; kcm{at}

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While the field of lung transplantation has evolved considerably since the first lung transplant with long-term success was performed in 1983,1 the need for donated lungs to help patients with progressive end-stage lung diseases that do not respond to non-transplant therapies continues to outstrip the availability of lungs from organ donors.2 Many patients with certain types of lung disease or other characteristics such as short stature or ABO blood type O may be less likely to receive an organ offer than those with different profiles and are, therefore, more at risk to die while waitlisted and awaiting lung transplantation.3 4 Organ allocation systems need to evolve (along with improvements in technical and medical aspects of lung transplantation) to optimally balance fairness and efficacy in donor lung allocation while also attempting to minimise the risk of death without transplant for waitlisted patients, optimise post-transplant survival and quality of life and avoid unsustainable resource utilisation.

In this issue of the journal, Kourliouros et al 5 examined outcomes emanating from the donor lung allocation system used in the UK by examining National Health Service UK Transplant Registry data for a patient cohort (n=2213) comprised of all adult patients (≥16 years old) registered for lung transplantation between January 2004 and March 2014. Donor lung allocation to listed patients during this period of time was at the discretion of the specific transplant centre (there are five designated centres in the UK for adult lung transplantation) at which candidates were listed for transplantation, and decisions for which patient to transplant with available organs were based on clinical assessments that would often take into account both waiting times and the degree of acuity for a specific patient. Statistical analyses of the available data showed that disease-specific and key patient-specific factors had a significant impact on length of time from …

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  • Contributors This is a commissioned editorial with unique text and a unique table that have not been published in any journal or book.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Commissioned; internally peer reviewed.

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