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J Thorac Cardiovasc Surg 2002;124:250-258
© 2002 The American Association for Thoracic Surgery

Cardiothoracic Transplantation (TX)

Aggressive management of lung donors classified as unacceptable: Excellent recipient survival one year after transplantation

From the Department of Surgery, Division of Cardiothoracic Surgery, University of California, Davis, Medical Center, Sacramento,^a and the Division of Pulmonary Medicine and Critical Care Medicine, University of California San Francisco^b and the California Transplant Donor Network,^c San Francisco, Calif.

Read at the Twenty-seventh Annual Meeting of The Western Thoracic Surgical Association, San Diego, Calif, June 20-23, 2001.

Received for publication June 28, 2001. Revisions requested Aug 3, 2001; revisions received Nov 1, 2001. Accepted for publication Dec 7, 2001. Address for reprints: David M. Follette, MD, Department of Surgery, University of California, Davis Medical Center, 2nd Floor, Sacramento, CA 95817-1418 (E-mail: david.follette{at}ucdmc.ucdavis.edu).

Objective: A dire shortage of lungs for transplantation exists. We hypothesized that aggressive organ procurement organization management of lungs usually rated as unacceptable (ratio of PaO₂ to inspired oxygen fraction <150) might make them acceptable for transplantation. We also hypothesized that lungs from donors who died of trauma could be used for transplantation with recipient survival comparable with that seen with lungs from donors who died of nontraumatic causes.
Methods: From January, 1, 1995, through August 31, 2000, a total of 194 donors resulted in 228 lung transplants. Of these, 27 donors were deemed unacceptable for lung transplantation according to organ procurement organization protocol. We used the California Transplant Donor Network database to conduct a retrospective review of all 194 donors, including the 27 supposedly unacceptable donors who were treated with invasive monitoring (central venous pressure), methylprednisolone, fluid restriction, inotropic agents, bronchoscopy, and diuresis. We evaluated survivals at 30 days and 1 year of patients who received lungs rated as unacceptable and acceptable. In addition, we compiled data on recipient survival for a subgroup of 122 recipients with lungs from donors who died of trauma and compared these data with those of recipients who received lungs from donors who died of nontraumatic causes to see whether the donor's death by trauma resulted in higher recipient mortality.
Results: After aggressive organ procurement organization management, ratios of PaO₂ to inspired oxygen fraction, central venous pressures, fluid balances, dopamine requirements, and chest radiographs of unacceptable donors according to organ procurement organization criteria were comparable with those of acceptable donors. There were no significant differences in recipient mortality between groups at 30 days or 1 year after transplantation. Moreover, no significant difference was found in mortalities of recipients who received lungs from donors who died of traumatic and nontraumatic causes.
Conclusion: Aggressive organ procurement organization management of donors initially considered unacceptable may increase the number of lungs available for transplantation.

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