A recent redesign of the lung transplant allocation approach tried to make the distribution of lungs more fair, but it hurt very sick patients with type O blood, which meant that fewer transplants could happen.
(Photo: Getty Images/ Christophe Archambault)
A Flawed Algorithm Hurts Type O Patients
In March 2023, the Organ Procurement and Transplantation Network (OPTN) made the system more efficient and fair by removing area borders and adding a patient score. People with blood type O can only get lungs from people who also have type O. This lack of action made it much harder for these people to get lung transplants.
After six months, Type O patients got 35 fewer grafts than expected. A study from the University of Colorado found that the mistake cut the number of donations by 138.
A surgical doctor and co-author of the study in Colorado, Jesse Schold, said something like this should not happen. He clarified that blood type-based transfer rates may differ even if the problem is found and fixed by September 2023.
Doctors who do transplants said the OPTN should have been more open about the mistake. In a letter, they said the situation was "deeply troubling" and asked for a full probe. OPTN reviews are kept secret to ensure they are thorough, so no report has been made public.
The algorithm mistake is terrible for people who have had lung transplants. David Sperlein, 62, a type O patient, got COVID-19 in October 2022 and had to wait months for a lung donation. He was very sick and in a competition, but he didn't get a donor lung until January 2024.
Sperlein remembers that he thought the event could happen at any time. After about two months, though, he began to worry about when it might happen.
The medical head of the lung transplant program at the University of Maryland, Dr. Robert M. Reed, said that the algorithm was a "perplexing mistake" that "discriminated" against type O patients. He saw that the number of O replacements at his center dropped by half because of the wrong rules. Things have improved since the fix, but Reed warned that people can get hurt by waiting too long.
READ ALSO: Man Gets Saved by Breast Implants During Lung Transplant Surgery
About Lung Transplant and Life Expectancy of Donees
Individuals with end-stage lung cancer require lung transplants; however, they encounter numerous complications. The University of Michigan Transplant Center has performed more than 700 lung transplants and has an 85% one-year survival rate and an 84% three-year survival rate. These types of high-volume sites perform better than those with modest volumes.
Whether a single or double lung transplant is done depends on the patient's health. Multiple donations keep the new lung from infecting people with cystic fibrosis. Fewer people survive five years after a lung transplant than five years after any other organ transplant.
Technology like mobile ECMO and ex-vivo lung perfusion (EVLP) is making it possible for more people to donate lungs and help patients get better. ECMO lets patients do things while they wait for a transplant, while EVLP makes it easier for transplant-worthy lungs that are only partly damaged.
Lung transplantation is hard to do, and the problems with the allocation formula show how important it is to have accurate and fair ways to distribute resources. To provide life-saving treatments, these systems need to be open and keep getting better.
RELATED ARTICLE: First Covid to Covid Double-Lung Operation Brought a Man Back to Life
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