title: Single-lung transplantation in the United States: what happens to the other lung?
abstract: BACKGROUND
  This study assessed treatment patterns and examined organ utilization in the setting of single-lung transplantation (SLT).
  
  
  METHODS
  The United Network for Organ Sharing database was queried for all SLTs performed from 1987 to 2011. Trends in utilization of the second donor lung were assessed, both from recipient and donor perspectives. Donors were stratified into 2 groups: those donating both lungs and those donating only 1 lung. Independent predictors of using only 1 donor lung were identified using multivariable logistic regression.
  
  
  RESULTS
  We identified 10,361 SLTs originating from 7,232 unique donors. Of these donors, both lungs were used in only 3,129 (43.3%), resulting in more than 200 second donor lungs going unused annually since 2005, with no significant increase in use over time (p = 0.95). After adjustment, donor characteristics predicting the second donor lung going unused included B/AB blood groups (adjusted odds ratio [AOR]: 1.69 and 2.62, respectively; p < 0.001), smaller body surface area (AOR, 1.30; p = 0.02), lower donor partial pressure of arterial oxygen (AOR, 0.90 per 50 mm Hg increase; p < 0.001), pulmonary infection (AOR, 1.15; p = 0.04), extended criteria donor status (AOR, 1.66; p < 0.001), and death caused by head trauma (AOR, 1.57; p < 0.001) or anoxia (AOR, 1.53; p = 0.001).
  
  
  CONCLUSIONS
  Among donors for SLT, less than half of all cases led to use of the second donor lung. Although anatomic, infectious, or other pathophysiologic issues prohibit 100% utilization, more aggressive donor matching efforts may be a simple method of increasing the utilization of this scarce resource, particularly for less common blood types.
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, North Carolina. Electronic address: paul.speicher@duke.edu.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Speicher
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Asvin M
authors.initials: AM
authors.lastname: Ganapathi
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Brian R
authors.initials: BR
authors.lastname: Englum
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Brian C
authors.initials: BC
authors.lastname: Gulack
authors.affiliation: Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Asishana A
authors.initials: AA
authors.lastname: Osho
authors.affiliation: Duke University School of Medicine, Durham, North Carolina.
authors.forename: Sameer A
authors.initials: SA
authors.lastname: Hirji
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Anthony W
authors.initials: AW
authors.lastname: Castleberry
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, North Carolina.
authors.forename: Laurie D
authors.initials: LD
authors.lastname: Snyder
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: R
authors.initials: R
authors.lastname: Duane Davis
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Hartwig
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016040:Lung Transplantation / Q000379:methods / Q000706:statistics & numerical data*; D008297:Male; D012189:Retrospective Studies; D014019:Tissue Donors / Q000600:supply & distribution*; D009927:Tissue and Organ Procurement / Q000458:organization & administration*; D014481:United States; D014850:Waiting Lists; D055815:Young Adult
keywords: donor allocation; resource utilization; single-lung transplantation