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Heart/lung

Submitting LAS exception requests for candidates diagnosed with PH

 Audience: Physicians, surgeons, coordinators, UNetSM Site Administrators, program directors, and data coordinators at lung and heart/lung transplant programs.

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 your PH candidate’s LAS,you 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 you believe that your patient has similar waiting list mortality and potential transplant benefit as a PH patient meeting the above criteria, then you should provide a detailed narrative on that assertion and reference literature that supports your request for a higher LAS. Always provide a clinical justification for the exception.

Policy Reference

Refer to Policy 10.2.B (Lung Candidates with Exceptional Cases) for additional information about the exception review process.

The policy 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 October 20, 2017 are as follows:

Questions?

Contact the UNetSM Help Desk at 1-800-978-4334 or unethelpdesk@unos.org. You may also contact your review board staff member: Regions 1 to 11 – Aaron McKoy at (804) 782-6575

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