title: Impact of a lung transplantation donor-management protocol on lung donation and recipient outcomes.
abstract: 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.
authors.affiliation: 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
authors.forename: Luis F
authors.initials: LF
authors.lastname: Angel
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Levine
authors.forename: Marcos I
authors.initials: MI
authors.lastname: Restrepo
authors.forename: Scott
authors.initials: S
authors.lastname: Johnson
authors.forename: Edward
authors.initials: E
authors.lastname: Sako
authors.forename: Andrea
authors.initials: A
authors.lastname: Carpenter
authors.forename: John
authors.initials: J
authors.lastname: Calhoon
authors.forename: John E
authors.initials: JE
authors.lastname: Cornell
authors.forename: Sandra G
authors.initials: SG
authors.lastname: Adams
authors.forename: Gary B
authors.initials: GB
authors.lastname: Chisholm
authors.forename: Joe
authors.initials: J
authors.lastname: Nespral
authors.forename: Ann
authors.initials: A
authors.lastname: Roberson
authors.forename: Stephanie M
authors.initials: SM
authors.lastname: Levine
mesh_terms: 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