Shipping lungs greater distances increases costs without cutting waitlist mortality.

Abstract Background On November 24th, 2017, a change in lung allocation policy was initiated to replace the Donor Service Area (DSA) with a 250-nautical-mile radius circle around the donor hospital. We aim to analyze the consequences of this change, including organ acquisition cost and transplant outcomes, at the national level. Methods Data on adult patients undergoing lung transplantation between 4/27/2017 and 6/22/2018 (30 weeks prior, to 30 weeks following allocation policy change) were extracted from the Scientific Registry of Transplant Recipients (SRTR) database. Patients were classified into pre-change and post-change subgroups. Six-month overall survival was evaluated via Kaplan-Meier analysis. Organ acquisition costs were compared between the pre-change and post-change groups. Results Of the 3317 adult patients removed from the waiting list during the study period (pre-change 1637 vs. post-change 1680), 2734 underwent transplantation (pre-change 1371/1637 [83.8%] vs. post-change 1363/1680 [81.1%]) and 382 died or became too sick to be transplanted (pre-change 168/1637 [10.3%] vs. post-change 214/1680 [12.7%], P=0.077). Six-month survival rates of transplanted patients were similar between the two groups. However, average organ acquisition costs increased after policy change (pre-change $50735±10858 vs. post-change $53440±10247, P Conclusions Organ acquisition costs and resource utilization increased with the new lung allocation policy, while deaths on the waiting list or after transplantation did not decrease. Further optimization of the allocation policy is necessary to balance access to transplant and proper stewardship of human and financial resources.