The new Composite Allocation Score (CAS) system developed to improve equity in organ allocation by eliminating geographic barriers and prioritizing candidates’ medical needs results in a decrease in waiting-list deaths among lung transplant candidates, according to a study published in the American Journal of Transplantation. Maryam Valapour, MD, and colleagues compared discrete CAS scenarios to the current concentric circle-based allocation system to assess their potential effects on the US lung transplantation system. Using data from individuals on the lung transplant waiting list from January 1, 2018 through December 31, 2019, six alternative CAS scenarios were compared across 10 simulations. A decrease of 36% to 47% in waiting-list deaths across scenarios was noted, with larger decreases in deaths at lower placement efficiency weight and higher weighting of the waiting-list outcomes. More transplants occurred in individuals with the highest expected post-transplant survival when waiting-list outcomes were equally weighted to post-transplant outcomes. Improved overall measures of equity were seen for all CAS scenarios compared with
the current Lung Allocation Score system, including reduced waiting-list deaths, resulting in similar post-transplant survival.
