Impact of a lung transplantation donor-management protocol on lung donation and recipient outcomes.
BACKGROUND
One of the limitations associated with lung transplantation is the lack of available organs.


OBJECTIVE
To determine whether a lung donor-management protocol could increase the number of lungs for transplantation without affecting the survival rates of the recipients.


METHODS
We implemented the San Antonio Lung Transplant protocol for managing potential lung donors according to modifications of standard criteria for donor selection and strategies for donor management. We then compared information gathered during a 4-yr period, during which the protocol was used with information gathered during a 4-yr period before protocol implementation. Primary outcome measures were the procurement rate of lungs and the 30-d and 1-yr survival rates of recipients.


RESULTS
We reviewed data from 711 potential lung donors. The mean rate of lung procurement was significantly higher (p < 0.0001) during the protocol period (25.5%) than during the pre-protocol period (11.5%), with an estimated risk ratio of 2.2 in favor of the protocol period. More patients received transplants during the protocol period (n = 121) than during the pre-protocol period (n = 53; p < 0.0001). Of 98 actual lung donors during the protocol period, 53 (54%) had initially been considered poor donors; these donors provided 64 (53%) of the 121 lung transplants. The type of donor was not associated with significant differences in recipients' 30-d and 1-yr survival rates or any clinical measures of adequate graft function.


CONCLUSIONS
The protocol was associated with a significant increase in the number of lung donors and transplant procedures without compromising pulmonary function, length of stay, or survival of the recipients.
Angel
Luis F
LF
Division of Pulmonary and Critical Care Medicine, Division of Cardiothoracic Surgery, Center for Epidemiology and Biostatistics, University of Texas Health Science Center at San Antonio, TX 78229. angel@uthscsa.edu
Levine
Deborah J
DJ
Restrepo
Marcos I
MI
Johnson
Scott
S
Sako
Edward
E
Carpenter
Andrea
A
Calhoon
John
J
Cornell
John E
JE
Adams
Sandra G
SG
Chisholm
Gary B
GB
Nespral
Joe
J
Roberson
Ann
A
Levine
Stephanie M
SM
D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016040:Lung Transplantation / Q000401:mortality / Q000706:statistics & numerical data*; D008297:Male; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013781:Texas / Q000453:epidemiology; D014019:Tissue Donors / Q000600:supply & distribution*; D009927:Tissue and Organ Procurement / Q000592:standards* / Q000706:statistics & numerical data