Will New Rules Change Your Wait for a Kidney or Lung?

Transplant experts explain

organ transplant process

The wait for a donor kidney or lung may get shorter — at least for some on transplant wait lists. That’s because of recent changes to the U.S. transplant system.

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In December 2014, the Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) introduced a new way of matching transplant candidates with donor kidneys. In February 2015, it changed how candidates are matched with donor lungs.

Here’s what Cleveland Clinic transplant experts want you to know about the changes:

What changed about kidney matching?

“We’ve moved from a first-come-first-served system to one based on longevity matching,” says David Goldfarb, MD, Surgical Director of Cleveland Clinic’s Renal Transplantation Program. “Now, patients who are likely to live the longest will get kidneys expected to last the longest.”

This is important because about 10 to 20 percent of kidney recipients today outlive their donor kidney and eventually need a repeat transplant.

Reducing the number of repeat transplants will help reduce the number of people on the wait list (currently more than 100,000). And that should make the line move faster for everyone.

“Younger patients can expect to be matched with more durable kidneys,” says Dr. Goldfarb. “Older patients may be matched with less durable kidneys, which may be a good fit for them. For some, faster availability is more important than longer durability.”

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One thing hasn’t changed. Wait time is still an important factor in kidney matching.

However, wait time used to begin whenever a patient joined the wait list. Now it can be retroactive to when a patient began dialysis — even if he or she didn’t join the wait list until later.

This helps even the playing field for patients who may have been unaware of transplant options before or weren’t able to have a transplant evaluation for other reasons.

What changed about lung matching?

In February 2015, lung transplant experts updated the formula that determines patients’ lung allocation scores (LAS).

LAS rates a patient’s likelihood of benefiting from a lung transplant on a scale of 0 to 100. The higher the score, the higher the benefit and the sooner the match.

LAS is based on many factors, including:

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  • Age
  • Diagnosis
  • Flow rate of supplemental oxygen
  • Continuous mechanical ventilation

Among other changes, the formula now includes new factors, such as bilirubin levels and heart function, explains Maryam Valapour, MD, MPP, Director of Lung Transplant Outcomes at Cleveland Clinic.

That’s better for the current mix of people on the wait list, she says, which includes sicker and older people. Historically, these people weren’t on the list because they couldn’t survive the wait for a donor lung.

“People with pulmonary hypertension and other pulmonary vascular diseases now have increased access to lung transplants,” says Dr. Valapour.

If you’re waiting for a kidney or lung

According to UNOS, changes to both kidney and lung matching should help improve transplant access for many patients without significantly compromising wait times for others.

Talk to your doctor about what these changes mean for you.

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