Thoracic: Lung Transplantation
Characteristics of donor lungs declined on site and impact of lung allocation policy change

Read at the 102nd Annual Meeting of The American Association for Thoracic Surgery, Boston, Massachusetts, May 14-17, 2022.
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Abstract

Objective

National and institutional data suggest an increase in organ discard rate (donor lungs procured but not implanted) after a new lung allocation policy was introduced in 2017. However, this measure does not include on-site decline rate (donor lungs declined intraoperatively). The objective of this study is to examine the impact of the allocation policy change on on-site decline.

Methods

We used a Washington University (WU) and our local organ procurement organization (Mid-America Transplant [MTS]) database to abstract data on all accepted lung offers from 2014 to 2021. An on-site decline was defined as an event in which the procuring team declined the organs intraoperatively, and the lungs were not procured. Logistic regression models were used to investigate potentially modifiable reasons for decline.

Results

The overall study cohort comprised 876 accepted lung offers, of which 471 donors were at MTS with WU or others as the accepting center and 405 at other organ procurement organizations with WU as the accepting center. At MTS, the on-site decline rate increased from 4.6% to 10.8% (P = .01) after the policy change. Given the greater likelihood of non-local organ placement and longer travel distance after policy change, the estimated cost of each on-site decline increased from $5727 to $9700. In the overall group, latest partial pressure of oxygen (odds ratio [OR], 0.993; 95% confidence interval [CI], 0.989-0.997), chest trauma (OR, 2.474; CI, 1.018-6.010), chest radiograph abnormality (OR, 2.902; CI, 1.289-6.532), and bronchoscopy abnormality (OR, 3.654; CI, 1.813-7.365) were associated with on-site decline, although lung allocation policy era was unassociated (P = .22).

Conclusions

We found that nearly 8% of accepted lungs are declined on site. Several donor factors were associated with on-site decline, although lung allocation policy change did not have a consistent impact on on-site decline.

Section snippets

Data Collection and Study Population

We leveraged a prospectively maintained multi-institutional collaborative database of LT donors and recipients to perform a retrospective cohort study of adult and pediatric donor lungs rejected on-site at the donor institution. Participating institutions included Barnes Jewish Hospital, St Louis Children's Hospital (collectively referred to as Washington University, WU), and Mid-America Transplant (MTS), our local organ procurement organization (OPO). Data for all on-site declines between

Results

The overall study cohort comprised 876 accepted lung offers, of which 471 donors were at MTS (accepting center WU or others) and 405 donors at multiple other OPOs with WU as the accepting center (Figure 1). The mean age of donors was 34.0 years, the median best partial pressure of oxygen (PAO2) was 513.5 mm Hg, the median latest PAO2 was 455.5 mm Hg, and cerebrovascular disease was the most common cause of death (219/876, 25.0%). Of these accepted donor offers, 395 were prechange and 481 were

Discussion

In this study, we noted that nearly 8% of donor lungs are declined on site by the procuring team and that change in lung allocation policy may exacerbate this problem. We also found that elevated creatinine kinase levels, lower latest PAO2, history of chest trauma, history of heavy alcohol use, any chest radiograph abnormality, and any bronchoscopy abnormality in the donor were associated with on-site decline (Figure 2).

Data describing the incidence and reasons behind on-site decline, which is

References (29)

Cited by (1)

This work was supported by National Institutes of Health grant 1 R01 HL146856-01A1 (to V.P.) and Mid-America Transplant Foundation grant 022017 (to V.P.).

Drs Terada and Takahashi contributed equally to this article.

This paper was handled by Associate Editor, Sudish Murthy, MD.

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