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Heart/lung

Submitting LAS exception requests for candidates diagnosed with PH

Audience

We are providing this information to all lung transplant physicians, lung transplant surgeons, lung transplant coordinators, UNetSM Site Administrators, transplant program directors, and data coordinators at lung and heart/lung transplant programs. Please share this notice with anyone in your organization who would benefit from this information. This information is also posted monthly on our member website, Transplant Pro.

 Reminder: LAS Revisions were implemented on February 19, 2015

Revisions to the Lung Allocation Score (LAS) were implemented on February 19, 2015. The revisions include policy changes and changes to UNetSM. Visit the toolkit on the OPTN website for resources to help with this transition.

 Submitting Lung Allocation Score Exception Requests for Candidates Diagnosed with Pulmonary Hypertension

 Guideline

Lung transplant candidates diagnosed with pulmonary hypertension (PH) and who meet the following criteria may qualify for an increase in their Lung Allocation Score (LAS):

  1. Patient is deteriorating on optimal therapy, and
  2. Patient has a right atrial pressure greater than 15 mm Hg or a cardiac index less than 1.8 L/min/m2.

To request an increase in a PH candidate’s LAS, transplant programs must submit an exception request to the Lung Review Board (LRB); this request should include sufficient clinical detail to support that the patient meets the above criteria.

If the transplant program believes that its patient has similar waiting list mortality and potential transplant benefit as a PH patient meeting the criteria listed above, then it should provide a detailed narrative on that assertion, referencing literature supporting the request for a higher LAS. When submitting an exception request, transplant programs must provide a clinical justification for the exception. Please refer to Policy 10.2.B (Lung Candidates with Exceptional Cases) for additional information about the exception review process.

Policy 10.2.B allows a transplant program to submit an exception request for an LAS, an estimated value for one of the tests that is used to calculate the LAS, or assignment to a diagnosis group for a disease that is not listed in WaitlistSM.

 Note:  The LRB will render clinical judgment on exception requests for higher LAS, diagnosis, or estimated value.

Transplant programs may wish to submit to the LRB an exception request for the candidate’s LAS to be at the national 90th percentile (see table below).

The LAS for all active candidates greater than or equal to 12 years of age waiting for lung transplants as of August 24, 2018 are as follows:

 

Aaron McKoy (804) 782-6575If you have questions, please contact the UNetSM Help Desk at 1-800-978-4334 or unethelpdesk@unos.org. You may also contact your review board staff member:

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