Sebelius: I Can’t Step Into Girl’s Transplant Case (When Other Children Are Just As Sick.)

[Yo_Mama]

24. Apparently they are on the same list, but the criteria are different

Wiki:

Before 2005, donor lungs within the United States were allocated by the United Network for Organ Sharing on a first-come, first-served basis to patients on the transplant list. This was replaced by the current system, in which prospective lung recipients of age of 12 and older are assigned a lung allocation score or LAS, which takes into account various measures of the patient's health. The new system allocates donated lungs according to the immediacy of need rather than how long a patient has been on the transplant list. Patients who are under the age of 12 are still given priority based on how long they have been on the transplant waitlist. The length of time spent on the list is also the deciding factor when multiple patients have the same lung allocation score.

They're on the same list, but they're working off different criteria. The young ones are also matched for size, which apparently with the staple routine doesn't matter as much for transplants between adolescents and various-sized adults.

http://en.wikipedia.org/wiki/Lung_transplantation

This is the UNOS explanation of how their current policy works:
http://www.unos.org/docs/Lung_Patient.pdf

LAS is calculated for those over 12. Pediatric and adolescent lungs are offered FIRST to pediatric and adolescent patients.

Here's a paper discussing most of the current US system:
http://www.atsjournals.org/doi/full/10.1513/pats.200808-095GO

Timing of transplantation is also influenced by the underlying allocation system. One of the byproducts of the success of lung transplantation has been a steady increase in the number of adults undergoing lung transplantation (5, 20). Thus children are facing increased competition with adults for organs; this may explain why the ratio of transplants to waiting list deaths in pediatric candidates remains higher than that in adults (21). Because the principles for allocation of organs include a directive to “recognize the differences in health and in organ transplantation issues between children and adults throughout the system and adopt criteria, polices, and procedures that address the unique health care needs of children,” and because end-stage organ dysfunction has a significant impact on growth and development, priority has been given to children in U.S. transplant allocation systems (22). In 2005, when the allocation of lungs in the United States was modified to incorporate allocation to candidates over 12 years of age based on a combination of transplant benefit and medical urgency (23), these principles led to including preferential allocation of lungs from pediatric donors to pediatric recipients. However, this system provides limited benefit to children under 12. Because the diversity in diagnoses and small numbers of young pediatric patients was felt to preclude development of accurate models of lung transplant waiting list outcomes, lung transplant candidates under 12 years old were not included in the new algorithm and continue to receive organs only on the basis of waiting time. A mechanism to stratify younger patients based on medical urgency is on the horizon, however. Recognizing that infants carry the highest waiting list mortality rate among all transplant candidates, the OPTN board recently approved a series of proposals to direct organs from donors under 11 years old to younger children first (24–26). The proposal for lung transplant candidates prioritizes children under 12 awaiting lung transplant based on objective medical urgency criteria, and distributes organs from donors under 12 over a much greater distance before offering them to older children or adults (25). These proposals are currently scheduled to be programmed into the OPTN computer system in 2009 and will hopefully reduce waiting list mortality for infants and young children.

In 2010 the change was made to rank pediatric patients as Priority 1 or Priority 2s based on need.

The median survival time for pediatric patients is 4.3 years, which is not that far below adults.