The Journal of Thoracic and Cardiovascular Surgery
Thoracic: Lung TransplantationCharacteristics of donor lungs declined on site and impact of lung allocation policy change
Graphical abstract
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
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2023, Journal of Thoracic and Cardiovascular Surgery
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.