Royal Papworth Hospital study shows lung transplant scheme reduced waiting times for sickest patients
A study led by academics at Royal Papworth Hospital suggests changes in how lung transplant patients are prioritised to receive donor organs has dramatically cut waiting times for the sickest patients.
The UK Lung Allocation Scheme (Uklas) was launched in 2017 to cut out geographical boundaries in transplant allocation and it introduced a national list of patients split into three groups – those with ‘super urgent’ need, ‘urgent’ need and’ non-urgent’ need.
Experts examined data on lung transplants across the UK between March 2015 and November 2016 – before the scheme was introduced – and from May 2017 to January 2019. Some 461 joined the waiting list in the first period and 471 after Uklas was launched.
The odds of a transplant within six months increased by 41 per cent after Uklas was rolled out by NHS Blood and Transplant (NHSBT).
Before 2017, the average waiting time for donor lungs was 427 days. After the scheme was launched, patients with super urgent need waited an average of eight days for a transplant and those with urgent need waited 15 days. Waiting times did increase for the non-urgent patients with an average wait of time of more than a year and a half (585 days).
Researchers found 15 per cent of people died while on the waiting list during the first period and this dropped to 13 per cent after the scheme was launched.
Post-transplant survival also increased – before the scheme, 81 per cent of patients survived for at least a year, and this rose 83 per cent.
Writing in the journal Thorax, academics stressed the true impact on death rates and survival data requires further work but added: “The Uklas scheme prioritises the critically ill and improves transplantation odds.”
One of the authors, Jasvir Parmar, a transplant consultant at Royal Papworth, said: “Creating the urgent categories led to a dramatic reduction on the median waiting times to transplant and, moreover, it did not disadvantage non-urgent registrations, with 30 per cent and 27 per cent of listed patients undergoing lung transplantation within six months of registration, before and after Uklas introduction, respectively, with no difference in waiting list deaths.
“The new policy has fulfilled its goals of prioritising the most critically ill and improving the odds of transplantation. Although no improvement was seen in waiting list deaths and the numbers of lung transplants, the true impact of the new scheme is yet to be seen and will likely continue to evolve as transplant teams adjust their practices to harness its full potential.”
Dale Gardiner, associate medical director for deceased organ donation at NHSBT, added: “The revised lung allocation scheme was developed to ensure timely allocation of donor lungs to those most in need. Geographic boundaries were replaced by a national waiting list prioritised by clinical urgency.
“We are always working to further improve organ allocation policies and we’re pleased to be driving innovation – but without donors no transplants would be possible, so we encourage people to confirm their support for organ donation on the NHS Organ Donor Register.”
Georgie Cooper, 26, from Chelmsford, Essex, received a lung transplant in 2021 from the urgent waiting list. She has cystic fibrosis and was considered to be weeks from death by the time of her transplant.
She said: “Before my transplant I was suffocating with every breath I tried to take. I am so happy I could be prioritised for an urgent transplant.
“Knowing that if you get sicker, the system adjusts, really helps. It was amazing to feel the air in my lungs after my transplant. I feel reborn. I am so grateful to the donor and their family, they are my heroes.”
Health minister Andrea Leadsom said: “I encourage everyone to register their organ donation decision – share it with your family so your loved ones can follow your wishes and save lives.”
Visit organdonation.nhs.uk or call the NHS Donor Line on 0300 123 23 23.
