Error in new lung transplant algorithm harmed sick and dying patients

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A flawed new algorithm for distributing lungs to transplant patients wound up putting people with Type O blood at a disadvantage.

David Sperlein, shown with his wife, Jeannine, at their home in Manchester, Maryland, was in need of a lung transplant during a period when a flaw in the distribution process put patients with type O blood at a disadvantage. He received a donor lung in January.

The problem occurred over a six-month period in 2023 but is only now coming to light publicly amid a dispute over how many patients were affected and whether the organization governing transplants should have been more transparent in explaining what went wrong. In a paper presented this month to the American Transplant Congress, a University of Colorado team argued for a higher number, calculating that the error likely resulted in 138 fewer lung transplants for type O patients. The O blood type is the most common, amounting to nearly half the U.S. population.

In response to written questions about the number of patients harmed by the error, the network said “it is not possible to accurately predict the number of patients that would have received a transplant or would have lived or died based on a certain policy because there are a variety of dynamic factors that contribute to a person receiving a transplant that vary per each unique organ, including the characteristics of a donated organ , a transplant center’s acceptance of an individual organ for...

Determining who gets available donor organs is governed by a formula based on factors including someone’s level of need, likelihood of survival, biological aspects such as blood type or height, patient access to transplant centers, and efficiency, which includes logistics and distance. Not long after the revised algorithm was implemented in lungs, however, the network realized that it was putting patients with type O blood at a disadvantage.

The report later noted that “the number of transplants decreased for blood type O recipients and increased for recipients of all other blood types.” In its response to the surgeons, the network said that its monitoring report “worked as intended to identify trends that deviated from the project outcomes” and that it disclosed the problems appropriately to stakeholders.

“I am an O-blood type and have been on the ‘Wait’ list for five months. I have not even had a dry run!” one unnamed commenter wrote. “To say I don’t feel like I’m in the game is an understatement. I have always felt being an O-patient has been a disadvantage. I commend OPTN for identifying the disparity with O patients and I support corrective life saving changes to the CAS point system.”

 

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