Assessment of lungs for transplantation: a stepwise analysis of 476 donors.
OBJECTIVE
This study aims to assess the suitability rates and the causes of lung-donor refusal, to determine which factors could be improved to expand the donor pool available for transplantation (LTx).


METHODS
Lung donors offered to our Lung Transplantation Unit from October 1993 to December 2007 were reviewed to assess the causes of unsuitability. The donor-lung evaluation was divided into three stages: stage 1 (PaO(2)/FiO(2) ratio, chest X-ray, bronchoscopic findings), stage 2 (donor-lung inspection and palpation) and stage 3 (assessment of grafts after harvesting). Variables from donors and recipients were analysed and compared between 1993-2001 (group A) and 2002-2007 (group B). An additional subgroup of extended donors was analysed to assess the recipient outcomes.


RESULTS
A total of 476 lung donors were assessed (278 men and 198 women; mean age 29+/-13 years). Causes of death were trauma in 255, intracranial bleeding in 202 and others in 19. As many as 273 donors were suitable for LTx (57%; 162 double LTx and 111 single LTx). Acceptability rates were 68%, 58% and 57% at stages 1, 2 and 3, respectively, and were significantly higher in group B than in group A (overall: 64% vs 54%; stage 2: 91% vs 79%), with no changes in stages 1 and 3. Abnormal bronchoscopy precluded LTx in 79 cases (16%). Group B donors were older (p=0.000), ventilated longer (p=0.07) and with shorter ischaemic times (p=0.000) than group A. In the recipients, primary graft dysfunction (PGD) (17% vs 15%) and 30-day mortality (11% vs 6%) did not differ between both the groups. No differences were observed between extended and ideal donors in terms of recipient 30-day mortality (extended 6% vs ideal 9%; p=0.315) and development of PGD (extended 21% vs ideal 15%; p=0.342).


CONCLUSIONS
Despite the high rate of organ donation in Spain, the acceptability rate remains low (57%), mainly due to failure to meet the criteria for acceptance at the early stages of donor-lung assessment. Improvements in multi-organ donor care must be made to expand the lung-donor pool. The use of extended donors does not seem to have a negative impact on recipient outcomes.
Alvarez
Antonio
A
Department of Thoracic Surgery and Lung Transplantation Unit, University Hospital Reina Sofía, Córdoba, Spain. aalvarez53@gmail.com
Moreno
Paula
P
Espinosa
Dionisio
D
Santos
Francisco
F
Illana
Jennifer
J
Algar
Francisco Javier
FJ
Baamonde
Carlos
C
Salvatierra
Angel
A
D000293:Adolescent; D000328:Adult; D001999:Bronchoscopy; D002648:Child; D046148:Donor Selection / Q000379:methods*; D005260:Female; D006801:Humans; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D010313:Partial Pressure; D055031:Primary Graft Dysfunction / Q000209:etiology; D014019:Tissue Donors / Q000706:statistics & numerical data* / Q000600:supply & distribution; D020858:Tissue and Organ Harvesting / Q000379:methods / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D055815:Young Adult
D010100:Oxygen