Using Hospital-Free Days to Understand the Impact of Lung Allocation Policy Changes on Older Lung Transplant Recipients

Lung transplantation is a potentially life-extending treatment for people with serious lung diseases. However, many lung transplant recipients, especially those who are frail, experience distressing symptoms and disability after transplant, leading to unplanned emergency department (ED) visits and hospitalizations.

In May 2017, a change in the policies for allocating donor lungs to patients on the waitlist led to an increase in transplants among the sickest candidates on the waitlist, who are often also the oldest.

While this policy change has not been associated with mortality rates post-transplant, we know that focusing only on mortality can miss important aspects of the experience of lung transplant survivors, such as quality of life and repeat hospitalizations. In this project, we used data on ED visits and hospitalizations among lung transplant recipients before and after the 2017 policy change to investigate whether shifting lung allocation to older and sicker patients on the waitlist impacted the number of days patients spend alive and out of the hospital after transplant.

Data collection for this study is complete and analysis is ongoing. We are in the process of preparing manuscripts for publication.

We presented preliminary findings at the American Thoracic Society International Conference, 2025.

Penn Population Aging Research Center (PARC) Quartet Pilot Award