242.1: DCD lungs increase the lung donor pool: One OPO’s 11-year experience with DCD lung allocation.

Abstract

Background: Between 2008 and 2018, 2,365 U.S. patients on the UNOS lung transplant waiting list died and an additional 1,817 became too sick to transplant. One way of reducing these adverse outcomes is through the utilization of lungs from DCD donors. Methods: This was a single OPO, multi-center study. DCD lungs were placed on EVLP to further evaluate lung quality or assess possible ischemic injury based on the surgeon’s intraoperative assessment and access to EVLP at their respective center. Results: Between 2008 and 2018, this OPO recovered 933 DCD donors including 52 (6%) DCD lung donors. The number of DCD donors from whom lungs were recovered for transplant annually increased from 2 (3%) in 2008 to 15 (11%) in 2018. The mean age of DCD donors overall was 38 years (s=0.51, r= 0.07– 69) and the mean age of DCD lung donors was 38 years (s=1.88, r=13 - 56). The mean WIT was 37 minutes (s=25, r=2 – 214) for all DCD donors and 39 minutes (s=2.68, r=11 – 114) for DCD lung donors. DCD recoveries were 84% controlled (n=803) vs. 16% uncontrolled (n=130), and DCD lung recoveries were 94% controlled (n=49) vs. 6% uncontrolled (n=3). In 12 cases, the lungs were placed on EVLP. Both lungs were declined for 25/52 (48%) DCD lung donors, 17 were declined subsequent to intraoperative evaluation and an additional 8 were declined subsequent to EVLP. Lungs were accepted for 28 (16 double, 12 single) DCD lung recipients at 7 centers (including 2 local, 2 regional and 3 national centers). DCD lung graft survival was 93% at 6 months and 88% at 1 year. Conclusions: DCD lungs can be utilized with satisfactory transplant outcomes. OPOs should develop protocols to increase utilization of DCD lungs.