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.