1. OPTN Proposal to Revise the Lung Allocation Score (LAS) System and Salient Activities of the Thoracic Organ Transplantation Committee

2. OPTN 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. OPTN 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. OPTN 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. OPTN Analytical Modeling  SRTR performed analyses to update the LAS system  SRTR validated its analyses that resulted in the revised LAS system

6. Percent Survival Days on Waitlist 0 180 365 Days since Transplant 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 SRTR

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

9. OPTN 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. OPTN 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. OPTN 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. OPTN Policy Proposal  See pages 66 to 110 in the public comment document for the policy modifications: Proposal #5: http://optn.transplant.hrsa.gov/policiesAndB ylaws/publicComment/proposals.asp

13. OPTN Questions?

14. OPTN Salient Activities of the Thoracic Organ Transplantation Committee Mark Barr, MD – Chair Steve Webber, MD – Vice-Chair Regional Meetings March – June, 2012

15. OPTN 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. OPTN Questions?

17. OPTN Extra Slides (Revised LAS Proposal)

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

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

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

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

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