Availability of Lungs for Transplantation: Exploring the Real Potential of the Donor Pool

Abstract

It is important to utilize all lung donor offers to maximize lung transplant (LTx) opportunities. This report describes the results of strategies that have evolved to evaluate and optimize cadaveric donor lung function and intra- and post-operative ICU management. Ongoing interactions between the intensive care unit (ICU) staff, donor coordinators and the LTx team all contribute to this process. Data are compared with the annual reports of the 2005 USA Organ and Transplant Procurement Network and UK Transplant. In 2001, 41% of all local (State of Victoria) multiple-organ donors referred for LTx were transplanted at the Alfred Hospital, with 36% considered functionally unusable. In 2006, 66% of Victorian donors contributed lungs for LTx (18% functionally unusable, 16% logistically unusable). Of the interstate (rest of Australia) lung donor offers, 50% (no local LTx unit present) and 32% (local LTx unit with first offer) were utilized, with 33% and 48% functionally unusable, respectively. Of the 47 resultant Alfred Hospital LTxs in 2006, survival rates were 100% at 180 days and 96% at 365 days, with no mortality directly attributable to donor quality. Overall, 54% (91 of 163) of Australian organ donor offers were used for LTx (i.e., 4.5 per million population [PMP]), compared with 17% in the USA (3.8 PMP) and 13% in the UK (2.0 LTx donors PMP) in 2005. A strategy of peri-operative lung donor evaluation and intervention suggests the number of truly unusable donor lungs is only a small fraction of the overall donor pool. In Australia, this strategy makes a significant difference in lung retrieval and transplantation rates, despite an intrinsically low (10 PMP) national donor rate.