Current LAS Policy

1. Proposal to Revise the Lung Allocation Score (LAS) SystemandSalient Activities of the Thoracic Organ Transplantation Committee

2. Current LAS Policy • Prioritizes candidates who are at least 12 years of age for allocation of deceased donor lung offers • Categorizes candidates into diagnosis groups: A, B, C, and D

3. Why Modify the Current LAS Policy? • Does not reflect the current waiting list population • Has not been revised thoroughly since its implementation in 2005

4. Goals in Modifying LAS System • Address the disease severity of candidates by modifying the covariates in the system’s statistical models • Updating the covariates’ coefficients • Update the baseline survival rates to reflect the current waiting list and transplant population • Including the LAS equation, baseline survival rates, and other rules that contribute to a candidate’s LAS in policy

5. Analytical Modeling • SRTR performed analyses to update the LAS system • SRTR validated its analyses that resulted in the revised LAS system

6. Waitlist Urgency Measure Shaded area under curve = Expected number of days lived without a transplant during an additional year on the waitlist Post-Transplant Survival Measure Shaded area under curve = Expected number of days lived during the first year post-transplant Percent Survival Percent Survival 0 180 365 0 180 365 Days on Waitlist Days since Transplant SRTR

7. Revised LAS Policy Would… • Likely Provide benefit to some candidates in Group B (pulmonary hypertension) by: • Increasing their Lung Allocation Scores • Improving their allocation rankings • Better addressing the increase in waiting list mortality associated with acute worsening of candidates with pulmonary hypertension

8. Change in LAS (Revised LAS – Current LAS) by Diagnosis Group for Candidates on the Waitlist℠ on January 1, 2010

9. Revised LAS Policy Would… • Likely increase the allocation rankings for candidates in all diagnosis groups who have: • Poor functional statuses; • Low cardiac indices; • High creatinine values; • High central venous pressures; and • Need for ventilation support

10. Inclusion of the LAS System’s Components that Are Rules but Are Not in Policy Today • Equation to calculate the LAS • Baseline survival rates • Coefficient for each covariate in the model • Complete listing of diseases in each group • Identification of values that will be substituted for covariate data that are missing or expired

11. Data Collection Required by Policy Modification • Entry of data for the following three new covariates for LAS calculation purposes: • Bilirubin (new to Waitlist℠) • Cardiac index (already in Waitlist℠) • Central venous pressure (already in Waitlist℠)

12. Policy Proposal • See pages 66 to 110 in the public comment document for the policy modifications:Proposal #5:http://optn.transplant.hrsa.gov/policiesAndBylaws/publicComment/proposals.asp

13. Questions?

14. Salient Activities of the Thoracic Organ Transplantation CommitteeMark Barr, MD – ChairSteve Webber, MD – Vice-ChairRegional MeetingsMarch – June, 2012

15. Committee’s Activities • Revising the pediatric heart policy for medical currency • Revising the adult heart policy for medical currency • Continuing efforts to modify the joint heart-lung policy • Working with the OPO committee to develop appropriate guidance for allocation of lungs supported using ex vivo lung perfusion

16. Questions?

17. Extra Slides (Revised LAS Proposal)

18. Scatter Plot of Current and Revised LASs by Diagnosis Group for Candidates on the Waitlist℠ on January 1, 2010

19. Current and Revised Model LAS, by Age Group (Diagnosis Group A Candidates)

20. Current and Revised Model LAS, by Age Group (Diagnosis Group B)

21. Current and Revised Model LAS, by Age Group (Diagnosis Group C)

22. Current and Revised Model LAS, by Age Group (Diagnosis Group D)