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J Thorac Cardiovasc Surg 2007;133:530-531
© 2007 The American Association for Thoracic Surgery

Cardiothoracic Transplantation

Discussion

Dr J. Wain (Boston, Massachusetts). I thank the Society for the opportunity to discuss the article and congratulate Dr De Perrot and the Toronto group on an impressive experience and a timely presentation for us about lung transplantation. The issue of a limited supply of donors for lung transplantation is truly critical at the present time, and the group here is certainly to be congratulated for the courage to take donors in increasing numbers, both 60 and 70 years of age or older, as well as the forthright presentation of the results in using these donors themselves. I think the general conclusion of the study, that donors more than 60 years of age can provide acceptable organs for lung transplantation in selected circumstances, is sound and valid. The results of the study certainly underscore the paradigm that, short of active malignancy, no one single demographic or physiologic characteristic should rule out a potential lung donor candidate, and clearly age should be thrown out based on this experience. I have 4 questions. First, the time course of the study, 1994 to 2005—did you use any older donors before 1994? Was that the first year that you began using those donors?

Dr De Perrot. Yes, 1994 was the first year a donor older than 60 years was used in our experience.

Dr Wain. Great. That’s what I presumed was probably the case, because you can clearly see from the graph that you were using more and more of the donors over time.

Second, why do you think it is that the older donors don’t do as well in recipients with a diagnosis of pulmonary fibrosis or pulmonary hypertension? Do you think there is intrinsic disease in those donor lungs . . . [Full Text of this Article]