2021 Articles

Leveraging Machine Perfusion to Ameliorate Geographic Disparities in Organ Allocation

Soled, Derek; Noah, Cray

Geographic inequities in access to donor lungs have persisted since the first successful lung transplant in 1983. With unanswered questions regarding organ preservation and transport in the early days of transplantation, the United Network of Organ Sharing (UNOS) understandably incorporated geography in the allocation algorithm. Today, geography is still the most influential criterion in the lung allocation algorithm. As a result, patients in urban centers often receive transplants before patients in less-resourced rural areas.


Ex vivo machine perfusion can significantly improve lung procurement and transport, offering longer preservation times before, after, or during transportation. Out-of-hospital perfusion centers, a recent addition to the healthcare field, may increase both the number of lungs available and potentially the distance they can travel. Before the adoption of machine perfusion becomes commonplace, UNOS should direct how to integrate machine perfusion into procurement networks best and shed the antiquated geographical confines that govern allocation today and compromise the ethical standards on which the field was founded.