Analyzing the Economic and Logistical Impact of Lung Procurement on Transplant Centers in the Era of Continuous Distribution.

OBJECTIVE

The recent transition to the Composite Allocation Score (CAS) has increased travel distances for lung transplants, but an associated cost analysis has not been performed. We assessed travel costs and short-term outcomes of lung transplantation before and after transitioning to CAS.

METHODS

The United Network for Organ Sharing database was queried for all lung transplants from 1/2020 to 12/2024. Redo and pediatric lung and multiorgan transplants were excluded. Patients were stratified between pre- and post-CAS, which began on 3/9/2023. Outcomes were distance of donor-to-recipient in nautical miles (nm), inflation-adjusted travel costs, and perioperative outcomes.

RESULTS

A total of 7,835 (58.6%) pre-CAS and 5,538 (41.4%) post-CAS patients were included. Post-CAS patients were more likely female (41.7% vs. 38.5%, p<0.001), less likely White race (69.1% vs. 72.7%, p<0.001), and had shorter waitlist durations (28 vs. 33 days, p<0.001) compared to pre-CAS patients. Donor lungs were procured from greater distances in the CAS era (411 vs. 185 nm, p<0.001). Post-CAS, more procurements required flights (80.8% vs. 68.6%, p<0.001), and very long-distance procurements (>1000 nm) increased (10.7% vs. 2.0%, p<0.001). Travel costs increased, with median inflation-adjusted costs rising from $13,967 to $16,818; p<0.001. Ischemic times were longer post-CAS (7.1 vs. 5.7 hours, p<0.001). Importantly, one-year survival was similar pre- and post-CAS (88.9% vs. 90.1%, p=0.069).

CONCLUSIONS

CAS has reduced waitlist duration with preserved one-year survival for lung transplant patients, but introduces greater logistical complexity and cost, which requires continued reevaluation to ensure economic viability and long-term sustainability of transplant programs.