. 2023 Feb 1;20(2):226–235. doi: 10.1513/AnnalsATS.202202-105OC

Table 5.

Comparing pulmonologists’ and surgeons’ perspectives on differential selection in lung transplantation

Theme	Exemplar Quote
Optimizing the recipient	17. “I think the main thing that we’re looking to do, and I’m not sure it’s the LAS number, or severity. I think we’re certainly always looking to maximize... I mean, maximize isn’t the right word. I think we want to be sure that the score as accurately as possible reflects the patient’s severity of illness. So whether that’s updating various testing parameters periodically, it’s certainly an awareness of the patient’s underlying condition and relatively aggressive assessment of changes to that condition in an effort to try to optimize the allocation score.” [pulmonologist]
Optimizing the donor	18. “The lung allocation score only creates the potential offer. It doesn’t control the quality of the offer. If you have a situation with a patient with a high score who is likely to become a candidate for a number of offers, then a lung that is marginal may not be readily accepted. And instead, one would say, ‘Hold out for a better organ, so we have a better outcome proposition’. But what is a better organ is in the eye of the beholder. And there is some science, but no real class evidence or truly binding guidelines or regulations feasible because it remains a big black box. It’s just experienced surgeons and physicians trying to extrapolate data that helps them decide what would or wouldn’t be a functional organ. Because you want to avoid the high-risk recipient with a marginal donor lung because the combination makes for an extremely difficult postoperative course, in the vast majority of cases, and therefore, increases dramatically your chance of 30-day mortality or 1-year mortality.” [surgeon]

Theme

Exemplar Quote

Optimizing the recipient

17. “I think the main thing that we’re looking to do, and I’m not sure it’s the LAS number, or severity. I think we’re certainly always looking to maximize... I mean, maximize isn’t the right word. I think we want to be sure that the score as accurately as possible reflects the patient’s severity of illness. So whether that’s updating various testing parameters periodically, it’s certainly an awareness of the patient’s underlying condition and relatively aggressive assessment of changes to that condition in an effort to try to optimize the allocation score.” [pulmonologist]

Optimizing the donor

18. “The lung allocation score only creates the potential offer. It doesn’t control the quality of the offer. If you have a situation with a patient with a high score who is likely to become a candidate for a number of offers, then a lung that is marginal may not be readily accepted. And instead, one would say, ‘Hold out for a better organ, so we have a better outcome proposition’. But what is a better organ is in the eye of the beholder. And there is some science, but no real class evidence or truly binding guidelines or regulations feasible because it remains a big black box. It’s just experienced surgeons and physicians trying to extrapolate data that helps them decide what would or wouldn’t be a functional organ. Because you want to avoid the high-risk recipient with a marginal donor lung because the combination makes for an extremely difficult postoperative course, in the vast majority of cases, and therefore, increases dramatically your chance of 30-day mortality or 1-year mortality.” [surgeon]

Definition of abbreviation: LAS = lung allocation score.