Expanding Donor Age Criteria: The UK Experience

Abstract

Transplant programmes are increasingly considering extended criteria donors, including previous smokers and older-age donors. In January 2018, the UK lung donor offering criteria was increased to 74 years (74 years and 364 days) for both DBD and DCD lung donors, where the donor was a life-time non-smoker or had not smoked within the last 10 years. Prior to this, the upper age limit was 64 years for DCD donors and 69 years for DBD donors. This study aims to assess the impact of the UK extended lung donor age criteria on lung utilisation and transplant. Data were obtained from the UK Transplant Registry on all lung offers from DBD donors over 69 years and DCD donors over 64 years ('older donors'), between January 2018 and September 2019. Utilisation was defined as at least one lung accepted and transplanted. One-hundred and seventy-eight donors meeting the criteria for analysis were identified. Of these, 110 proceeded to donation of at least one solid organ. Lungs were offered from 52 potential DBD donors aged 70-74 years and 126 potential DCD donors aged 65-74 years. Six (11.5%) of the 52 DBD lungs were transplanted and 2 (1.6%) of the 126 DCD lungs were transplanted. Recipient age ranged from 50-66 years. One recipient was listed as urgent at the time of transplant. One-hundred and seventy older donor lung offers were declined. The most common primary reasons for decline recorded were 'past history' (29%), 'poor function' (20%), and 'age' (19%). The cardiothoracic retrieval team attended 28 of the total 178 older donor offers. Although the utilisation rate from older lung donors is low, expanding the donor age criteria in the UK has resulted in an additional 8 transplants, a 1.2% increase. This appears to have benefited the older, non-urgent recipient. Despite the published increases to the donor offering age criteria, 'age' continues to be documented as a reason for organ decline. Further work is required to understand and improve utilisation rates throughout UK lung transplant practice, including the use of older donors. We will continue to review the impact of expanding lung donor age criteria on UK practice, including analysis of recipient outcomes from older age donors.