Recent changes to Composite Allocation Score system improved rates for women, but disparities in access persist
By Elana Gotkine HealthDay Reporter
FRIDAY, Oct. 31, 2025 (HealthDay News) — Recent changes to the Composite Allocation Score (CAS) system improved lung transplantation rates for female candidates, but disparities in access persist, according to a study published online Oct. 8 in the Annals of Thoracic Surgery.
Peter D. Cho, from Drexel University College of Medicine in Philadelphia, and colleagues queried the United Network for Organ Sharing database for all adult candidates listed for isolated lung transplantation from March 2022 to March 2024 to assess access to transplantation and outcomes in male and female candidates and to examine the impact of recent changes to the CAS system. Based on the implementation date of the CAS system, two distinct eras were defined (era 1 and era 2); each was stratified by candidate gender.
The analysis included 6,878 patients: 3,311 in era 1 (40.7 percent female) and 3,567 in era 2 (42.7 percent female). Women experienced a lower transplant rate than men in era 1 (adjusted subhazard ratio, 0.68), but had similar waitlist mortality and posttransplant survival. Women had a lower transplant rate than men in era 2 (adjusted subhazard ratio, 0.84), and continued to have similar waitlist mortality and posttransplant survival.
“There was a modest improvement in narrowing the gap, but we still have a lot of work to do,” coauthor Abbas Ardehali, M.D., from the University of California, Los Angeles, said in a statement. “Further refinements to the scoring system are needed to ensure a fair and effective organ allocation system for all patients, regardless of gender.”
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