Lung transplant scheme reduced waits for sickest patients, study shows

Changes to the way lung transplant patients are prioritised to receive donor lungs has dramatically cut waiting times for the sickest patients, a study suggests.

An allocation scheme for lung transplants was introduced in 2017.

The system cut out geographical boundaries in lung transplant allocation and introduced a national list of patients.

Patients were also categorised by urgency and split into three groups: those with “super urgent” need; those with “urgent” need and those with “non-urgent” need.

The study, led by academics at the Royal Papworth Hospital in Cambridge, saw experts examine data on lung transplants across the UK between March 2015 and November 2016 – before the scheme was introduced – and from May 2017 to January 2019.

Some 461 joined the lung transplant waiting list in the first period and 471 joined the list after the UK Lung Allocation Scheme (Uklas) was launched.

They found that the odds of transplant within six months increased by 41% after the initiative was rolled out by NHS Blood and Transplant (NHSBT).

Before 2017, the average waiting time for donor lungs was 427 days.

After the scheme was launched, patients with super urgent need waited an average of eight days for transplant and those with urgent need waited 15 days.

Average waiting times did increase for patients classed as “non urgent” – with an average waiting time of more than a year and a half (585 days).

Researchers found that the proportion of people who died while on the waiting list reduced from 15% during the first period to 13% after the scheme was launched.

Post-transplant survival also increased – before the scheme was launched some 81% of patients survived for at least a year, this rose to 83% after Uklas was rolled out.

Writing in the journal Thorax, academics stressed that the true impact on death rates and survival data requires further work but added: “The Uklas scheme prioritises the critically ill and improves transplantation odds.”

One of the authors, Jasvir Parmar, a transplant consultant at the Royal Papworth Hospital, said: “Creating the urgent categories led to a dramatic reduction on the median waiting times to transplant and, moreover, it did not disadvantage non-urgent registrations, with 30% and 27% of listed patients undergoing lung transplantation within six months of registration, before and after Uklas introduction, respectively, with no difference in waiting list deaths.

“The new policy has fulfilled its goals of prioritising the most critically ill and improving the odds of transplantation.

“Although no improvement was seen in waiting list deaths and the numbers of lung transplants, the true impact of the new scheme is yet to be seen and will likely continue to evolve as transplant teams adjust their practices to harness its full potential.”

Dale Gardiner, associate medical director for deceased organ donation at NHS Blood and Transplant, said: “The revised lung allocation scheme was developed to ensure timely allocation of donor lungs to those most in need.

“Geographic boundaries were replaced by a national waiting list prioritised by clinical urgency into super-urgent, urgent and non-urgent tiers.

“We are always working to further improve organ allocation policies and we’re pleased to be driving innovation but without donors no transplants would be possible, so we encourage people to confirm their support for organ donation on the NHS Organ Donor Register.”

Georgie Cooper from Chelmsford, Essex, received a lung transplant in 2021 through the “urgent” waiting list.

The 26-year-old has cystic fibrosis and, by the time of her transplant, she was considered to be just weeks away from death.

“Before my transplant I was suffocating with every breath I tried to take,” said Ms Cooper, who works for Essex County Council.

“I am so happy I could be prioritised for an urgent transplant.

“Knowing that if you get sicker, the system adjusts, really helps. It was amazing to feel the air in my lungs after my transplant.

“I feel reborn. I am so grateful to the donor and their family, they are my heroes.”

Health Minister Andrea Leadsom said: “I encourage everyone to register their organ donation decision – share it with your family so your loved ones can follow your wishes and save lives.”

– To find out more about organ donation visit: www.organdonation.nhs.uk call 0300 123 23 23 or use the NHS app.