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Cleveland Clinic model for lung transplant prioritization could reduce deaths, study finds

Cleveland Clinic Sydell and Arnold Miller Family Pavilion
Tim Harrison
Ideastream Public Media
Researchers say their model could save the lives of some lung transplant candidates who die while waiting for the organ.

A team at the Cleveland Clinic has developed a new model for prioritizing lung transplant candidates who become sicker while waiting for a transplant.

Currently, patients in need of donor lungs are given a place in line based on a number of factors including how stable they are while waiting, chances of survival after receiving a new organ and how easily they can be matched for available organs, according to the Clinic. The scores are based on tests given twice a year at transplant centers.

“The problem with this method is that the scoring equations fail to consider how a patient’s health status changes as they spend more time on the list,” said Dr. Maryam Valapour, director of Lung Transplant Outcomes at Cleveland Clinic. “The longer a patient lives with a severe lung disease, the more their risk of developing severe complications increases. This is something clinicians observe every day — that our patients’ risk of developing complications changes over time. Therefore, some patients’ scores may not reflect how urgently they need a transplant.”

The Clinic study, published in the American Journal of Respiratory and Critical Care Medicine, accounted for lung disease type and time spent on the waitlist in determining who needs a transplant most urgently. When researchers applied the model to profiles of people on the lung transplant waitlist between 2015 and 2020, it consistently flagged those patients who died while waiting as high-priority recipients.

“In our simulations, we showed that deaths on the waiting list could be decreased through making sure that patients who are getting sicker are actually prioritized at an earlier point in time," said Clinic researcher Jarrod Dalton.

The new model could change the order of who gets lung transplants first, Dalton said. However, this is only the first step of several research projects that will seek to improve and validate their model, he said.

The Clinic's approach will continue to be studied before changes to the scoring equation for placement on the lung transplant waitlist are formally suggested, the researchers said.

The hope is unnecessary suffering and death among those waiting for a lung can be prevented, they said.

Taylor Wizner is a health reporter with Ideastream Public Media.