Update on the Continuous Distribution of Organs Project

At a glance

What is current practice and why address it?

The current system allocates lungs by placing candidates into categories that are considered and prioritized in sequence. When reviewed in sequence, sometimes candidates are placed on the side of a hard boundary that would stop them from being prioritized further on the match run. This proposed framework will consider multiple patient factors all at once with an overall score. This overall score includes not only medical urgency and patient outcomes, but also factors such as biologic match and efficiency of organ transport. This paper is an update from the Lung Committee and a request for community feedback through an exercise that will help inform the Committee’s work. Read more about continuous distribution.

Update on the Continuous Distribution of Organs Project

Dr. Erika Lease, Chair of the OPTN Lung Transplantation Committee, reviews the Update on the Continuous Distribution of Organs Project request for feedback item.

Terms you need to know

Attribute: Factor used to classify, sort, and prioritize candidates. For example, in this concept paper, lung allocation attributes include medical urgency, travel time, ischemic time, blood type compatibility, and others.
Composite Allocation Score: The total number of points assigned to a candidate on the wait list, which would determine their rank on a match run.
Rating Scale: Method used to calculate number of points awarded to candidates for each attribute. For example, if everything else is equal, should a candidate with twice as much medical urgency as another receive twice as many points? Applying the rating scale to each candidate’s information and combining it with the weight of the attribute results in an overall composite score for prioritizing candidates.

Click here to search the OPTN glossary

What’s been done since the last update?

Composite Allocation Score components determined
- 5 goals make up the score
  - Prioritize candidates who are expected to survive at least one year after receiving a transplant (Post-Transplant Survival)
  - Prioritize sickest candidates first to improve waitlist mortality (Medical Urgency)
  - Increase transplant opportunities for patients who are medically harder to match (Candidate Biology)
  - Increase transplant opportunities for patients under the age of 18 and patients who previously donated an organ/part of an organ (Patient Access)
  - Consider resources required to match, transport, and transplant an organ (Placement Efficiency)
- Each goal includes specific patient attributes
- Each attribute will have a rating scale
- Candidates receive points for each attribute
- These points combine into a total score for the candidate
The Committee needs community feedback on how to prioritize the attributes
- How much weight given to each attribute has not been determined
- There is no definitive “right” answer
- The Committee is inviting the donation and transplant community to participate in an exercise to help inform its decisions on the importance, or “weight”, of each attribute

What this concept could accomplish

Provide a more complete approach to matching candidates and donors
Remove hard boundaries that prevent candidates from being prioritized further on the match run
Establish a system that is flexible enough to work for each organ type on the match

What this concept wouldn’t do

This paper is not a proposed policy change

Themes to consider

Attributes identified to be included in score
Additional attributes that should be included
Weight of attributes in final score

Comments

ERROR | 12/22/2025

Could not retrieve comments for this proposal.