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278: Gender differences in symptom experiences before and up to 6 months after lung transplant (LT)
The Journal of Heart and Lung Transplantation Volume 26, Number 2S
Purpose: In many countries, consent for organ donation is taken following bereavement and is primarily the decision of the potential donor’s next of kin. Recent UK legislation may transfer the timing and primacy of this decision to the donor who may have registered advance intentions to donate on a national register. We hypothesised that postive televison media coverage of heart transplantation may affect the potential donor registration rate. Methods and Materials: We examined web-based requests to register on the UK Organ Donor Register between January 2005 and August 2006. Changes in registration numbers were compared according to media coverage events. Results: In the 20 month period there were 286,207 registration requests and 5 transplant topic television items. The mean registration rate was 14,310( 95%, CI 9951-18,668) per month. The number of registrations in months following media coverage were significatly higher than in those without (20,904(95% CI 11,115-30,694) versus 9,864(95%CI8047-681) p⫽0.006).The observed effect appeared greatest when a heart transplant related topic arose in a fictional “soap opera” with a high viewing audience compared to non-fictional coverage but this was not significant(p⫽0.27). This apparent effect of positive coverage was short lived. Registration rates fell to the previous baseline within a month of coverage. The greatest increase in registration was seen on the day of broadcast( 2.8 times previous rate). This enhanced rate halved within 24 hours. Conclusions: Positive media coverage increases advance registration rates to a National Donor Register. The effect is short lived and may be insufficient to change rates of actual transplantation. Nevertheless, such coverage together with other educational initiatives may increase the number of potential donors for consideration of transplantation. 276 TEACHING ON POSTOPERATIVE DAY ONE: A FEASIBLE APPROACH TO REDUCE LENGTH OF STAY IN VENTRICULAR ASSIST DEVICE PATIENTS M.A. Murray,1 J.A. Hoffmann,2 J. Drayton,3 S. Osaki,1 D. Murray,2 M.R. Johnson,2 N.M. Edwards,1 T. Kohmoto,1 1Cariothoracic Surgery, University of Wisconsin Hospital and Clinics, Madison, WI; 2Heart Failure and Transplant Cardiology, University of Wisconsin Hospital and Clinics, Madison, WI; 3Nursing Staff Development, University of Wisconsin Hospital and Clinics, Madison, WI Purpose: To assess if earlier patient education after initial ventricular assist device (VAD) implant decreases length of stay (LOS) without affecting readmission. Methods and Materials: A retrospective review of VAD patient medical records was conducted to compare outcomes prior to (July 2000-Dec 2003: 7 patients) and following (Jan 2004-Aug 2006: 33 patients) implementation of a new education process incorporating a multidisciplinary approach. Preoperative education focused on target LOS, VAD daily care, and activity level at discharge. On postoperative day one (POD1) education began to patients and families utilizing a tailored teaching style and continued daily through discharge. A subjective assessment of mental status, interest, and physical stamina determined patient readiness to learn. Each patient received a new patient manual. Outreach education within the patient’s community began early following VAD implantation. Objective assessment tested patient knowledge of VAD care and problem solving prior to discharge. Results: 76% (25/33) patients who received a VAD after Jan 2004 were male and mean age was 52 (range 36-67). Device types include: HeartMate XVE (25), HeartMate II (1), Thoratec LVAD (2), Thoratec RVAD (1), Thoratec BIVAD (2), and DeBakey (2). 71% (24/33) of patients were taught preoperatively. Teaching began POD1 in 88%
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(29/33) including 3 patients who remained intubated. Postoperative LOS decreased (60.4 ⫾ 31.8 days vs. 16.0 ⫾ 6.0 days p ⬍ 0.001). The 30 day readmission rate did not increase: 5/7 (71%) patients (3 infections, 1 hypervolemia, 1 RV failure) vs. 2/33 (0.06%) patients (anasarca, infection) (p⬍0.001). Conclusions: Early patient education, using a tailored teaching style and multidisciplinary approach beginning on POD1, is feasible and can reduce LOS without increasing readmission rates in VAD patients. Patients are well prepared to return to their communities by utilizing this approach.
277 CHALLENGES ASSOCIATED WITH DEVELOPMENT OF A ‘STAND-ALONE’ DONATION AFTER CARDIAC DEATH (DCD) LUNG TRANSPLANT (LTX) PROGRAM: TRANSLATING RESEARCH INTO REALITY B. Levvey,1 R. McEgan,2 T. Oto,1 A. Griffiths,1 M. Mennen,2 A. Davies,3 D. Pilcher,3 T. Williams,1 F. Rosenfeldt,4 G. Snell,1 1 Lung Transplant Service, Alfred Hospital, Melbourne, Victoria, Australia; 2Cardiac Perfusion Services, Alfred Hospital, Melbourne, Victoria, Australia; 3Intensive Care, Alfred Hospital, Melbourne, Victoria, Australia; 4Cardiothoracic Surgical Research, Alfred Hospital, Melbourne, Victoria, Australia Purpose: The use of DCD donors for LTx has gained momentum since first reported (Love, JHLT 1995; Steen, Lancet 2001) with experimental evidence published on the viability of lungs ⱕ 1hr post asystole. Static donor rates and increased LTx waiting list numbers prompted us to create a clinical DCD LTx program, which would be a ‘stand- alone’ program due to the absence of DCD guidelines for other organ within our region. The development of the country’s first DCD LTx program and introduction of Lung DCD guidelines at our institution provided many challenges. Methods and Materials: Experiments utilising the Swedish model of ex-vivo lung perfusion were performed to determine if DCD lung donation would be feasible within our current organ donation system. Following extensive consultation with international and local donor coordinators, intensive care unit (ICU) & LTx personnel, guidelines for Maastricht category 3 DCD lung retrieval and transplantation were formulated. Guidelines complied with relevant ethical & legal requirements, however it was important to ensure they were clinically applicable. As DCD donation was a new concept in our institution a comprehensive education program and refinement of guidelines was required prior to introduction. Results: Shortly post commencement of the program, a family consented to DCD lung donation (25yo male, major head trauma). Treatment was withdrawn in ICU, and donor transfered to operating theatre(OT) 23 mins after asystole. Total warm ishcaemic time was 53mins, and the recipient (34 yo female with PAH) is well at 3 months post LTx. In the absence of guidelines no other DCD organs were retrieved. Conclusions: Clinical, practical, legal and ethical issues were significant but proved surmountable. Nursing staff in ICU and OT found DCD challenging and required the most education and support. However, success with the first DCD lung retrieval and transplant resulted in consideration of another 4 potential DCD donors and significant potential for the program. Research Support; Cellcept Australia Research Grant (Roche).
278 GENDER DIFFERENCES IN SYMPTOM EXPERIENCES BEFORE AND UP TO 6 MONTHS AFTER LUNG TRANSPLANT (LT)
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Abstracts
D.M. Lanuza,1 C.A. Lefaiver,2 R.L. Brown,1 S.M. Bhorade,2,3 R. Love,4,2 1School of Nursing, University of Wisconsin-Madison, Madison, WI; 2Loyola University Medical Center, Maywood, IL; 3 Lung Transplant Program, Umiversity of Chicago, Chicago, IL; 4 Lung Transplant Program, University of Wisconsin Madison, Madison, WI Purpose: The purpose of this study was to describe male and female LT patients’ symptoms before and up to 6 months after LT. Methods and Materials: Subjects completed self-administered instruments before and at 1, 3, and 6 months after transplant. The Transplant Symptom Inventory, a 67-item, two-part instrument, measures symptom frequency and symptom distress on a 5-point likert scale. Rank order and change over time were analyzed with RIDIT analysis and Mantell-Hanzel chi-square. Significance was set at p ⬍0.05). Results: The sample consisted of 163 LT patients, the majority were white (96 females and 67 males. Before LT, both genders ranked shortness of breath (SOB) with activity as the most distressing and most frequently occurring symptom Six months after LT, both genders reported a significant decrease in the frequency of SOB with activity, the frequency and distress for SOB at rest, and a significant decrease in frequency of fatigue, chest tightness, and feelings of lack of control. Females also reported a significant decrease in the frequency of heart palpitations, tiring easily and feelings of helplessness. In contrast, male LT recipients reported a significant decrease in the distress associated with SOB with activity, tiring easily, feeling afraid and feeling sad. Males also reported significant decreases in the frequency of sleepiness, fever, and feeling depressed, helpless and irritable. Negative symptoms reported by females included a significant increase in the frequency of tremors. Negative symptoms reported by males included a significant increase in distress due to the frequent occurrence of tremors, nausea, vomiting, and stomach pain. Conclusions: At six months post LT, both genders reported significantly less SOB and fatigue and a significant decrease in the occurrence of feeling helpless. Male recipients reported more positive improvements as well as more negative symptoms than females. These findings underscore the importance of assessing changes in symptoms over time and to realize that gender differences exist. 279 QUALITY OF LIFE SURVEYS: ARE RESPONDERS DIFFERENT FROM NON-RESPONDERS? D. Naftel,1 S. Myers,1 J. Kirklin,1 K. Grady,2 1Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, AL; 2Cardiac Surgery, Northwestern Memorial Hospital, Chicago, IL Purpose: A major challenge in quality of life (QOL) research is to obtain a sample of responders who adequately represent the target patient (pt) group. Selection of pts based on convenience and self-exclusion may result in a biased sample. The purpose of this study was to determine whether consented pts differ from non-consented pts by demographics, clinical condition and subsequent outcomes, and the extent and reasons for missing data for the consented pts. Methods and Materials: Extensive QOL data at 5-10 yrs posttransplant (tx) were prospectively collected from a non-random sample of pts tx between 1990 and 1999 at 4 hospitals. Concerted efforts were made to enroll every eligible pt. Reasons for nonenrollment or withdrawal from the study were recorded. All eligible pts were also part of a separate clinical tx registry. Results: Of the 1437 tx pts, 386 pts died and 167 transferred care prior to target enrollment date, leaving 884 potentially eligible pts. Of these, 597 (68%) were consented. In the 287 non-consents, the reasons were: did not meet study inclusion criteria (n⫽53, 6%: 15
The Journal of Heart and Lung Transplantation February 2007
failed the literacy test, 35 did not speak English and 3 were re-tx), self-exclusion (n⫽127, 14%), unable to locate (n⫽70, 8%) and 37 died before contact. The consented and non-consented pts did not differ by age (p⫽.6) or gender (p⫽.4) but did differ by race (p⬍.001) with more non-whites as non-consentors, due to the English speaking requirement. Subsequent outcomes (death, rejection, infection) did not differ between the two groups. Among the 597 consented pts, 201 did not complete the time course of booklets due to death (n⫽41), noncompliance (n⫽70), lost to followup (n⫽15) and other self-exclusion reasons (n⫽75). Conclusions: Even in a well-controlled QOL study, enrolling a majority of pts is difficult. Pts who do not consent are similar in characteristics including major outcomes to the patients who consented. Retention of consented pts is problematic with 30% dropping out by 2 yrs. Longitudinal QOL studies require structured enrollment and compliance protocols to promote retention. 280 LUNG ALLOCATION SCORE IS NOT ASSOCIATED WITH HEALTH-RELATED QUALITY OF LIFE IN LUNG TRANSPLANT CANDIDATES A.J. Gurau,1,2 N. Chowdhury, L.G. Singer,1,2 1Toronto Lung Transplant Program, University Health Network, Toronto, ON, Canada; 2University of Toronto, Toronto, ON, Canada Purpose: The Lung Allocation Score (LAS), a new allocation system for donor lungs in the United States, was implemented in 2005. The LAS uses demographic and clinical variables to calculate each patient’s medical urgency prior to transplant, and the expected one-year post-transplant survival benefit. While the LAS was designed to maximize the survival benefit of transplantation, health-related quality of life (HRQL) is also important in transplant decision-making. We hypothesized that LAS is associated with HRQL of lung transplant candidates. Methods and Materials: Adult patients active on the lung transplant list at a single center between Nov 03-May 06 were eligible. Subjects completed a series of HRQL measures including EQ-5D, Standard Gamble, SF-36, and St. George’s Respiratory Questionnaire. LAS at the time closest to HRQL measurement was calculated retrospectively using the UNOS website tool. We used linear regression analysis to measure associations of LAS with HRQL scores. Because donor lungs are a public resource, our primary outcome measure was the EQ-5D, a utility measure derived from US population-based health state valuations. The EQ-5D is a global measure of health status, where 1⫽ideal health and 0⫽death. Results: Of 181 eligible patients, 118 completed HRQL assessments (58 male, median age 52). Diagnoses included interstitial lung disease (39%), COPD (19%), cystic fibrosis (18%), pulmonary hypertension (5%), sarcoidosis (9%), bronchiectasis (4%) and other (5%). Median LAS⫽36.1262, range 25.1508 to 71.4545. Median EQ-5D⫽0.705, range 0.167 to 1. LAS was not associated with EQ-5D (coefficient⫽0.000, 95% CI -0.004 to 0.004, p⫽0.9). Exclusion of 3 subjects with EQ-5D scores of 1 did not change this result. Of all other HRQL measures assessed, only the physical component summary of the SF-36 was associated with LAS (coefficient⫽-0.26, 95% CI -0.43 to -0.09, p⫽0.004). Conclusions: Lung transplant allocation by LAS does not select patients with the most severe impairments in HRQL as valued by the US general population. 281 CONGESTIVE HEART FAILURE OFFERING INDIVIDUALIZED CHOICE EVALUATION STUDY (CHOICES)
Purpose: In many countries, consent for organ donation is taken following bereavement and is primarily the decision of the potential donor’s next of kin. Recent UK legislation may transfer the timing and primacy of this decision to the donor who may have registered advance intentions to donate on a national register. We hypothesised that postive televison media coverage of heart transplantation may affect the potential donor registration rate. Methods and Materials: We examined web-based requests to register on the UK Organ Donor Register between January 2005 and August 2006. Changes in registration numbers were compared according to media coverage events. Results: In the 20 month period there were 286,207 registration requests and 5 transplant topic television items. The mean registration rate was 14,310( 95%, CI 9951-18,668) per month. The number of registrations in months following media coverage were significatly higher than in those without (20,904(95% CI 11,115-30,694) versus 9,864(95%CI8047-681) p⫽0.006).The observed effect appeared greatest when a heart transplant related topic arose in a fictional “soap opera” with a high viewing audience compared to non-fictional coverage but this was not significant(p⫽0.27). This apparent effect of positive coverage was short lived. Registration rates fell to the previous baseline within a month of coverage. The greatest increase in registration was seen on the day of broadcast( 2.8 times previous rate). This enhanced rate halved within 24 hours. Conclusions: Positive media coverage increases advance registration rates to a National Donor Register. The effect is short lived and may be insufficient to change rates of actual transplantation. Nevertheless, such coverage together with other educational initiatives may increase the number of potential donors for consideration of transplantation. 276 TEACHING ON POSTOPERATIVE DAY ONE: A FEASIBLE APPROACH TO REDUCE LENGTH OF STAY IN VENTRICULAR ASSIST DEVICE PATIENTS M.A. Murray,1 J.A. Hoffmann,2 J. Drayton,3 S. Osaki,1 D. Murray,2 M.R. Johnson,2 N.M. Edwards,1 T. Kohmoto,1 1Cariothoracic Surgery, University of Wisconsin Hospital and Clinics, Madison, WI; 2Heart Failure and Transplant Cardiology, University of Wisconsin Hospital and Clinics, Madison, WI; 3Nursing Staff Development, University of Wisconsin Hospital and Clinics, Madison, WI Purpose: To assess if earlier patient education after initial ventricular assist device (VAD) implant decreases length of stay (LOS) without affecting readmission. Methods and Materials: A retrospective review of VAD patient medical records was conducted to compare outcomes prior to (July 2000-Dec 2003: 7 patients) and following (Jan 2004-Aug 2006: 33 patients) implementation of a new education process incorporating a multidisciplinary approach. Preoperative education focused on target LOS, VAD daily care, and activity level at discharge. On postoperative day one (POD1) education began to patients and families utilizing a tailored teaching style and continued daily through discharge. A subjective assessment of mental status, interest, and physical stamina determined patient readiness to learn. Each patient received a new patient manual. Outreach education within the patient’s community began early following VAD implantation. Objective assessment tested patient knowledge of VAD care and problem solving prior to discharge. Results: 76% (25/33) patients who received a VAD after Jan 2004 were male and mean age was 52 (range 36-67). Device types include: HeartMate XVE (25), HeartMate II (1), Thoratec LVAD (2), Thoratec RVAD (1), Thoratec BIVAD (2), and DeBakey (2). 71% (24/33) of patients were taught preoperatively. Teaching began POD1 in 88%
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(29/33) including 3 patients who remained intubated. Postoperative LOS decreased (60.4 ⫾ 31.8 days vs. 16.0 ⫾ 6.0 days p ⬍ 0.001). The 30 day readmission rate did not increase: 5/7 (71%) patients (3 infections, 1 hypervolemia, 1 RV failure) vs. 2/33 (0.06%) patients (anasarca, infection) (p⬍0.001). Conclusions: Early patient education, using a tailored teaching style and multidisciplinary approach beginning on POD1, is feasible and can reduce LOS without increasing readmission rates in VAD patients. Patients are well prepared to return to their communities by utilizing this approach.
277 CHALLENGES ASSOCIATED WITH DEVELOPMENT OF A ‘STAND-ALONE’ DONATION AFTER CARDIAC DEATH (DCD) LUNG TRANSPLANT (LTX) PROGRAM: TRANSLATING RESEARCH INTO REALITY B. Levvey,1 R. McEgan,2 T. Oto,1 A. Griffiths,1 M. Mennen,2 A. Davies,3 D. Pilcher,3 T. Williams,1 F. Rosenfeldt,4 G. Snell,1 1 Lung Transplant Service, Alfred Hospital, Melbourne, Victoria, Australia; 2Cardiac Perfusion Services, Alfred Hospital, Melbourne, Victoria, Australia; 3Intensive Care, Alfred Hospital, Melbourne, Victoria, Australia; 4Cardiothoracic Surgical Research, Alfred Hospital, Melbourne, Victoria, Australia Purpose: The use of DCD donors for LTx has gained momentum since first reported (Love, JHLT 1995; Steen, Lancet 2001) with experimental evidence published on the viability of lungs ⱕ 1hr post asystole. Static donor rates and increased LTx waiting list numbers prompted us to create a clinical DCD LTx program, which would be a ‘stand- alone’ program due to the absence of DCD guidelines for other organ within our region. The development of the country’s first DCD LTx program and introduction of Lung DCD guidelines at our institution provided many challenges. Methods and Materials: Experiments utilising the Swedish model of ex-vivo lung perfusion were performed to determine if DCD lung donation would be feasible within our current organ donation system. Following extensive consultation with international and local donor coordinators, intensive care unit (ICU) & LTx personnel, guidelines for Maastricht category 3 DCD lung retrieval and transplantation were formulated. Guidelines complied with relevant ethical & legal requirements, however it was important to ensure they were clinically applicable. As DCD donation was a new concept in our institution a comprehensive education program and refinement of guidelines was required prior to introduction. Results: Shortly post commencement of the program, a family consented to DCD lung donation (25yo male, major head trauma). Treatment was withdrawn in ICU, and donor transfered to operating theatre(OT) 23 mins after asystole. Total warm ishcaemic time was 53mins, and the recipient (34 yo female with PAH) is well at 3 months post LTx. In the absence of guidelines no other DCD organs were retrieved. Conclusions: Clinical, practical, legal and ethical issues were significant but proved surmountable. Nursing staff in ICU and OT found DCD challenging and required the most education and support. However, success with the first DCD lung retrieval and transplant resulted in consideration of another 4 potential DCD donors and significant potential for the program. Research Support; Cellcept Australia Research Grant (Roche).
278 GENDER DIFFERENCES IN SYMPTOM EXPERIENCES BEFORE AND UP TO 6 MONTHS AFTER LUNG TRANSPLANT (LT)
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D.M. Lanuza,1 C.A. Lefaiver,2 R.L. Brown,1 S.M. Bhorade,2,3 R. Love,4,2 1School of Nursing, University of Wisconsin-Madison, Madison, WI; 2Loyola University Medical Center, Maywood, IL; 3 Lung Transplant Program, Umiversity of Chicago, Chicago, IL; 4 Lung Transplant Program, University of Wisconsin Madison, Madison, WI Purpose: The purpose of this study was to describe male and female LT patients’ symptoms before and up to 6 months after LT. Methods and Materials: Subjects completed self-administered instruments before and at 1, 3, and 6 months after transplant. The Transplant Symptom Inventory, a 67-item, two-part instrument, measures symptom frequency and symptom distress on a 5-point likert scale. Rank order and change over time were analyzed with RIDIT analysis and Mantell-Hanzel chi-square. Significance was set at p ⬍0.05). Results: The sample consisted of 163 LT patients, the majority were white (96 females and 67 males. Before LT, both genders ranked shortness of breath (SOB) with activity as the most distressing and most frequently occurring symptom Six months after LT, both genders reported a significant decrease in the frequency of SOB with activity, the frequency and distress for SOB at rest, and a significant decrease in frequency of fatigue, chest tightness, and feelings of lack of control. Females also reported a significant decrease in the frequency of heart palpitations, tiring easily and feelings of helplessness. In contrast, male LT recipients reported a significant decrease in the distress associated with SOB with activity, tiring easily, feeling afraid and feeling sad. Males also reported significant decreases in the frequency of sleepiness, fever, and feeling depressed, helpless and irritable. Negative symptoms reported by females included a significant increase in the frequency of tremors. Negative symptoms reported by males included a significant increase in distress due to the frequent occurrence of tremors, nausea, vomiting, and stomach pain. Conclusions: At six months post LT, both genders reported significantly less SOB and fatigue and a significant decrease in the occurrence of feeling helpless. Male recipients reported more positive improvements as well as more negative symptoms than females. These findings underscore the importance of assessing changes in symptoms over time and to realize that gender differences exist. 279 QUALITY OF LIFE SURVEYS: ARE RESPONDERS DIFFERENT FROM NON-RESPONDERS? D. Naftel,1 S. Myers,1 J. Kirklin,1 K. Grady,2 1Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, AL; 2Cardiac Surgery, Northwestern Memorial Hospital, Chicago, IL Purpose: A major challenge in quality of life (QOL) research is to obtain a sample of responders who adequately represent the target patient (pt) group. Selection of pts based on convenience and self-exclusion may result in a biased sample. The purpose of this study was to determine whether consented pts differ from non-consented pts by demographics, clinical condition and subsequent outcomes, and the extent and reasons for missing data for the consented pts. Methods and Materials: Extensive QOL data at 5-10 yrs posttransplant (tx) were prospectively collected from a non-random sample of pts tx between 1990 and 1999 at 4 hospitals. Concerted efforts were made to enroll every eligible pt. Reasons for nonenrollment or withdrawal from the study were recorded. All eligible pts were also part of a separate clinical tx registry. Results: Of the 1437 tx pts, 386 pts died and 167 transferred care prior to target enrollment date, leaving 884 potentially eligible pts. Of these, 597 (68%) were consented. In the 287 non-consents, the reasons were: did not meet study inclusion criteria (n⫽53, 6%: 15
The Journal of Heart and Lung Transplantation February 2007
failed the literacy test, 35 did not speak English and 3 were re-tx), self-exclusion (n⫽127, 14%), unable to locate (n⫽70, 8%) and 37 died before contact. The consented and non-consented pts did not differ by age (p⫽.6) or gender (p⫽.4) but did differ by race (p⬍.001) with more non-whites as non-consentors, due to the English speaking requirement. Subsequent outcomes (death, rejection, infection) did not differ between the two groups. Among the 597 consented pts, 201 did not complete the time course of booklets due to death (n⫽41), noncompliance (n⫽70), lost to followup (n⫽15) and other self-exclusion reasons (n⫽75). Conclusions: Even in a well-controlled QOL study, enrolling a majority of pts is difficult. Pts who do not consent are similar in characteristics including major outcomes to the patients who consented. Retention of consented pts is problematic with 30% dropping out by 2 yrs. Longitudinal QOL studies require structured enrollment and compliance protocols to promote retention. 280 LUNG ALLOCATION SCORE IS NOT ASSOCIATED WITH HEALTH-RELATED QUALITY OF LIFE IN LUNG TRANSPLANT CANDIDATES A.J. Gurau,1,2 N. Chowdhury, L.G. Singer,1,2 1Toronto Lung Transplant Program, University Health Network, Toronto, ON, Canada; 2University of Toronto, Toronto, ON, Canada Purpose: The Lung Allocation Score (LAS), a new allocation system for donor lungs in the United States, was implemented in 2005. The LAS uses demographic and clinical variables to calculate each patient’s medical urgency prior to transplant, and the expected one-year post-transplant survival benefit. While the LAS was designed to maximize the survival benefit of transplantation, health-related quality of life (HRQL) is also important in transplant decision-making. We hypothesized that LAS is associated with HRQL of lung transplant candidates. Methods and Materials: Adult patients active on the lung transplant list at a single center between Nov 03-May 06 were eligible. Subjects completed a series of HRQL measures including EQ-5D, Standard Gamble, SF-36, and St. George’s Respiratory Questionnaire. LAS at the time closest to HRQL measurement was calculated retrospectively using the UNOS website tool. We used linear regression analysis to measure associations of LAS with HRQL scores. Because donor lungs are a public resource, our primary outcome measure was the EQ-5D, a utility measure derived from US population-based health state valuations. The EQ-5D is a global measure of health status, where 1⫽ideal health and 0⫽death. Results: Of 181 eligible patients, 118 completed HRQL assessments (58 male, median age 52). Diagnoses included interstitial lung disease (39%), COPD (19%), cystic fibrosis (18%), pulmonary hypertension (5%), sarcoidosis (9%), bronchiectasis (4%) and other (5%). Median LAS⫽36.1262, range 25.1508 to 71.4545. Median EQ-5D⫽0.705, range 0.167 to 1. LAS was not associated with EQ-5D (coefficient⫽0.000, 95% CI -0.004 to 0.004, p⫽0.9). Exclusion of 3 subjects with EQ-5D scores of 1 did not change this result. Of all other HRQL measures assessed, only the physical component summary of the SF-36 was associated with LAS (coefficient⫽-0.26, 95% CI -0.43 to -0.09, p⫽0.004). Conclusions: Lung transplant allocation by LAS does not select patients with the most severe impairments in HRQL as valued by the US general population. 281 CONGESTIVE HEART FAILURE OFFERING INDIVIDUALIZED CHOICE EVALUATION STUDY (CHOICES)