Is it Safe to Use Lungs from 'Hanging Donors' for Transplantation?

Abstract

Objectives: Suicidal hanging may cause compression of the neck blood vessels and the airway leading to hypoxic brain damage due to cerebral ischemia and respiratory distress. Hanging, in addition to global tissue hypoxia, affects particularly the lungs due to pulmonary edema and barotrauma. There is little evidence in literature about outcomes of transplantation utilizing the lungs from 'hanging donors'. This study evaluates the outcome of lung transplantation (LTx) utilizing organs from this group. Methods: Retrospective analysis of lung offers and LTx between 01.2007 and 11.2013 with hanging as cause of death was performed. The outcomes of LTx utilizing the lungs from donors with hanging as cause of death (hanging group) were compared with those with donors with other causes of death (control group) using unadjusted model as well as propensity score matching. Results: 302 LTx were performed during this period and were grouped depending on the cause of death in donors - hanging group (n = 8) and control group (n = 294). To minimize the potential effects of selection bias on patient characteristics, we performed an additional analysis using one-to-three propensity score matching with 32 patients remaining for the analysis. The matching was performed based on donor and recipient characteristics which were statistically different between the two groups in the unadjusted analysis: presence of cardiac arrest and recipient age. Additionally, further clinically important variables such as donor gender, age, type of donation (DBD/DCD), and utilization of EVLP as well as recipient gender and primary diagnosis were used for calculation of propensity scores. After propensity score matching, there were no statistically significant differences in PaO2/FiO2 ratio on arrival at ICU as well as 24, 48 and 72 hours postoperatively. Ventilation duration, ICU and hospital length of stay, need for postoperative ECMO and incidence of BOS were also similar between 'hanging' and control group. Overall cumulative survival was not statistically different with 85.9% versus 75% in control and 'hanging' group, respectively (Log Rank (Mantel-Cox) p = 0.368) at 1 year which was continued at 3 years. Conclusions: Suicidal hanging is a relatively rare cause of death for potential organ donors. As it does not seem to negatively affect outcomes after LTx, it should not be considered as a contraindication for lung donation by itself.