Prognostic Markers and the LAS for Lung Transplantation: Impact of New Revisions for Successful Outcome
This chapter reviews the history, development, and institution of the lung allocation score (LAS) in the United States. Lung transplantation can be a lifesaving therapy for patients suffering with end-stage lung diseases for which there are no remaining therapeutic options available. Unfortunately, there remains an imbalance between the number of patients in need of this therapy and the availability of suitable donor organs for transplantation. The LAS was developed in the spirit of the important ethical principles in transplantation of utility and justice. More specifically, the objective of the LAS is to decrease waitlist time (and thus risk for waitlist mortality) and to allocate organs based upon medical urgency so as to balance predicted urgency with predicted benefit. The institution of the LAS for the allocation of suitable donor lungs to appropriate candidates on May 4, 2005, literally changed the landscape of lung transplantation overnight. This chapter also explores the ongoing evolution of the LAS as advancements continue to be made in medical therapies and technologies available for the support and management of end-stage lung diseases.
