{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T01:06:42Z","timestamp":1789002402854,"version":"build-2803163510"},"reference-count":40,"publisher":"BMJ","issue":"12","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Thorax"],"accepted":{"date-parts":[[2023,6,21]]},"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>A new UK Lung Allocation Scheme (UKLAS) was introduced in 2017, replacing the previous geographic allocation system. Patients are prioritised according to predefined clinical criteria into a three-tier system: the super-urgent lung allocation scheme (SULAS), the urgent lung allocation scheme (ULAS) and the non-urgent lung allocation scheme (NULAS). This study assessed the early impact of this scheme on waiting-list and post-transplant outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A cohort study of adult lung transplant registrations between March 2015 and November 2016 (era-1) and between May 2017 and January 2019 (era-2). Outcomes from registration were compared between eras and stratified by urgency tier and diagnostic group.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>During era-1, 461 patients were registered. In era-2, 471 patients were registered (19 (4.0%) SULAS, 82 (17.4%) ULAS and 370 (78.6%) NULAS). SULAS patients were younger (median age 35 vs 50 and 55 for urgent and non-urgent, respectively, p=0.0015) and predominantly suffered from cystic fibrosis (53%) or pulmonary fibrosis (37%). Between eras 1 and 2, the odds of transplantation within 6 months of registration were increased (OR=1.41, 95%\u2009CI 1.07 to 1.85, p=0.0142) despite only a 5% increase in transplant activity. Median time-to-transplantation during era-1 was 427 days compared with waiting times in era-2 of 8\u2009days for SULAS, 15 days for ULAS and 585 days for NULAS patients. Waiting-list mortality (15% era-1 vs 13% era-2; p=0.5441) and post-transplant survival at 1\u2009year (81.3% era-1 vs 83.3% era-2; p=0.6065) were similar between eras.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The UKLAS scheme prioritises the critically ill and improves transplantation odds. The true impact on waiting-list mortality and post-transplant survival requires further follow-up.<\/jats:p><\/jats:sec>","DOI":"10.1136\/thorax-2022-219475","type":"journal-article","created":{"date-parts":[[2023,7,24]],"date-time":"2023-07-24T17:20:24Z","timestamp":1690219224000},"page":"1206-1214","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Early experience of a new national lung allocation scheme in the UK based on clinical urgency"],"prefix":"10.1136","volume":"78","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4527-2400","authenticated-orcid":false,"given":"Ahmed","family":"Al-Adhami","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8547-9521","authenticated-orcid":false,"given":"Mohamed","family":"Al-Aloul","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sally","family":"Rushton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard Damian","family":"Thompson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Carby","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jordan","family":"Lordan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Clark","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen","family":"Spencer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven","family":"Tsui","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jasvir","family":"Parmar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,7,24]]},"reference":[{"key":"2024051320344943000_78.12.1206.1","unstructured":"NHS Blood and Transplant . Annual report on cardiothoracic organ transplantation 2017\/2018. 2018. Available: https:\/\/nhsbtdbe.blob.core.windows.net\/umbraco-assets-corp\/12252\/nhsbt-cardiothoracic-transplantation-annual-report-2017-2018.pdf"},{"key":"2024051320344943000_78.12.1206.2","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201109-1599OC"},{"key":"2024051320344943000_78.12.1206.3","doi-asserted-by":"publisher","DOI":"10.4037\/aacnacc2016792"},{"key":"2024051320344943000_78.12.1206.4","unstructured":"Zalewska K . Donor lung distribution and allocation NHS blood and transplant; 2017."},{"key":"2024051320344943000_78.12.1206.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2014.06.014"},{"key":"2024051320344943000_78.12.1206.6","unstructured":"Robinson C . Donor lung distribution and allocation. NHS Blood and Transplant; 2019."},{"key":"2024051320344943000_78.12.1206.7","doi-asserted-by":"crossref","DOI":"10.1111\/ctr.14210","article-title":"The impact of the SARS-Cov-2 pandemic and COVID-19 on lung transplantation in the UK: lessons learned from the first wave","volume":"35","author":"Hardman","year":"2021","journal-title":"Clin Transplant"},{"key":"2024051320344943000_78.12.1206.8","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1016\/j.healun.2016.01.010","article-title":"Effect of the lung allocation score on lung transplantation in the United States","volume":"35","author":"Egan","year":"2016","journal-title":"J Heart Lung Transplant"},{"key":"2024051320344943000_78.12.1206.9","doi-asserted-by":"publisher","DOI":"10.1378\/chest.07-1160"},{"key":"2024051320344943000_78.12.1206.10","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2009.04.024"},{"key":"2024051320344943000_78.12.1206.11","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1111\/ajt.12584","article-title":"OPTN\/SRTR 2012 annual data report: lung","volume":"14 Suppl 1","author":"Valapour","year":"2014","journal-title":"Am J Transplant"},{"key":"2024051320344943000_78.12.1206.12","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1111\/ajt.16495","article-title":"OPTN\/SRTR 2019 annual data report: lung","volume":"21 Suppl 2","author":"Valapour","year":"2021","journal-title":"Am J Transplant"},{"key":"2024051320344943000_78.12.1206.13","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1111\/ajt.16991","article-title":"OPTN\/SRTR 2020 annual data report: lung","volume":"22 Suppl 2","author":"Valapour","year":"2022","journal-title":"Am J Transplant"},{"key":"2024051320344943000_78.12.1206.14","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1093\/ejcts\/ezy035","article-title":"Five-year experience using the lung allocation score: the Munich lung transplant group","volume":"54","author":"Schuba","year":"2018","journal-title":"Eur J Cardiothorac Surg"},{"key":"2024051320344943000_78.12.1206.15","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2007.08.044"},{"key":"2024051320344943000_78.12.1206.16","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2010.06.018"},{"key":"2024051320344943000_78.12.1206.17","doi-asserted-by":"crossref","DOI":"10.1111\/ctr.13298","article-title":"Lung transplantation in the lung allocation score era: medium-term analysis from a single center","volume":"32","author":"Iyengar","year":"2018","journal-title":"Clin Transplant"},{"key":"2024051320344943000_78.12.1206.18","doi-asserted-by":"crossref","first-page":"2164","DOI":"10.1111\/ajt.15307","article-title":"Unintended consequences of changes to lung allocation policy","volume":"19","author":"Puri","year":"2019","journal-title":"Am J Transplant"},{"key":"2024051320344943000_78.12.1206.19","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201408-1562OC"},{"key":"2024051320344943000_78.12.1206.20","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1097\/MOT.0000000000000743","article-title":"Development of a UK liver transplantation selection and allocation scheme","volume":"25","author":"Gimson","year":"2020","journal-title":"Curr Opin Organ Transplant"},{"key":"2024051320344943000_78.12.1206.21","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0b013e3181c9029d"},{"key":"2024051320344943000_78.12.1206.22","doi-asserted-by":"crossref","first-page":"908","DOI":"10.1002\/ppul.23432","article-title":"Influence of graft ischemic time on survival in children with cystic fibrosis after lung transplantation","volume":"51","author":"Hayes","year":"2016","journal-title":"Pediatr Pulmonol"},{"key":"2024051320344943000_78.12.1206.23","doi-asserted-by":"crossref","first-page":"3631","DOI":"10.1111\/ajt.16098","article-title":"Impact of the elimination of the donation service area on United States lung transplant practices and outcomes at high and low competition centers","volume":"20","author":"Drolen","year":"2020","journal-title":"Am J Transplant"},{"key":"2024051320344943000_78.12.1206.24","unstructured":"NHS Blood and Transplant . Annual report on cardiothoracic organ transplantation 2020\/2021; 2021."},{"key":"2024051320344943000_78.12.1206.25","unstructured":"NHS Blood and Transplant . Annual report on cardiothoracic organ transplantation 2021\/2022; 2022."},{"key":"2024051320344943000_78.12.1206.26","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2018-211731"},{"key":"2024051320344943000_78.12.1206.27","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00166412"},{"key":"2024051320344943000_78.12.1206.28","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2014.08.072"},{"key":"2024051320344943000_78.12.1206.29","doi-asserted-by":"publisher","DOI":"10.1378\/chest.07-0490"},{"key":"2024051320344943000_78.12.1206.30","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200810-1603OC"},{"key":"2024051320344943000_78.12.1206.31","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(97)06405-2"},{"key":"2024051320344943000_78.12.1206.32","unstructured":"Public Health England . 2nd Atlas of variation in risk factors and Healthcare for respiratory disease in England; 2019."},{"key":"2024051320344943000_78.12.1206.33","doi-asserted-by":"crossref","first-page":"1491","DOI":"10.1111\/ajt.15182","article-title":"Geographic disparities in lung transplant rates","volume":"19","author":"Kosztowski","year":"2019","journal-title":"Am J Transplant"},{"key":"2024051320344943000_78.12.1206.34","doi-asserted-by":"crossref","first-page":"1471","DOI":"10.1111\/ajt.14630","article-title":"Geographic disparities in donor lung supply and lung transplant Waitlist outcomes: a cohort study","volume":"18","author":"Benvenuto","year":"2018","journal-title":"Am J Transplant"},{"key":"2024051320344943000_78.12.1206.35","doi-asserted-by":"crossref","first-page":"2971","DOI":"10.1111\/ajt.17160","article-title":"Expected effect of the lung composite allocation score system on US lung transplantation","volume":"22","author":"Valapour","year":"2022","journal-title":"Am J Transplant"},{"key":"2024051320344943000_78.12.1206.36","doi-asserted-by":"crossref","first-page":"6504","DOI":"10.21037\/jtd-2021-17","article-title":"The new allocation era and policy","volume":"13","author":"Benvenuto","year":"2021","journal-title":"J Thorac Dis"},{"key":"2024051320344943000_78.12.1206.37","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2011.04.122"},{"key":"2024051320344943000_78.12.1206.38","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1016\/j.athoracsur.2018.02.036","article-title":"Contemporary outcomes of extracorporeal membrane oxygenation used as bridge to lung transplantation","volume":"106","author":"Hakim","year":"2018","journal-title":"Ann Thorac Surg"},{"key":"2024051320344943000_78.12.1206.39","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1055\/s-0035-1546429","article-title":"Extracorporeal life support in \"awake\" patients as a bridge to lung transplant","volume":"63","author":"Mohite","year":"2015","journal-title":"Thorac Cardiovasc Surg"},{"key":"2024051320344943000_78.12.1206.40","doi-asserted-by":"crossref","first-page":"516","DOI":"10.1097\/MAT.0000000000000843","article-title":"Improving outcomes in bridge-to-transplant: extended extracorporeal membrane oxygenation support to obtain optimal donor lungs for marginal recipients","volume":"65","author":"Langer","year":"2019","journal-title":"ASAIO J"}],"container-title":["Thorax"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/thorax-2022-219475","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,14]],"date-time":"2024-05-14T03:50:58Z","timestamp":1715658658000},"score":1,"resource":{"primary":{"URL":"https:\/\/thorax.bmj.com\/lookup\/doi\/10.1136\/thorax-2022-219475"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,24]]},"references-count":40,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2023,11,20]]},"published-print":{"date-parts":[[2023,12]]}},"alternative-id":["10.1136\/thorax-2022-219475"],"URL":"https:\/\/doi.org\/10.1136\/thorax-2022-219475","relation":{},"ISSN":["0040-6376","1468-3296"],"issn-type":[{"value":"0040-6376","type":"print"},{"value":"1468-3296","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,7,24]]}}}