Predictors of Pediatric Donor Lungs Non-Utilization: A 10-Year Nationwide Cohort Study

Abstract

<h3>Purpose</h3> While lung transplantation appears as a therapeutic option in the pediatric population, the number of available pediatric donor lungs remains low. This especially affects the small children who require appropriately sized donor lungs. This seems mostly the result of low lung offer and acceptance rates from pediatric organ donors. Our study aimed to identify pediatric organ donor predictors of lung non-utilization. <h3>Methods</h3> All pediatric brain-dead donors (pBDD) registered in the national registry Cristal between January 2010 and December 2020 (n=628) with at list one organ recovered were included in this cohort study. Donors with heart-lung graft recovered were excluded. Donor demographics and clinical data as well as variables related to graft quality were investigated. The associations between potential risk factors for graft non-utilization and lung offer as well as lung procurement were studied. <h3>Results</h3> Among 628 pBDD from whom at least one organ was recovered, 278 (44%) had at least one lung offered and 173 (28%) one lung recovered. Pediatric organ donors considered as unsuitable for lung offer were more likely to be young children (p <0.01) with small body surface area (p <0.01), history of lung disease (p =0.03), anoxia as cause of death (p <0.01), cardiopulmonary resuscitation (p <0.01) and PaO2/FiO2 ratio <300 mmHg (p <0.01). Donors whose lungs were not accepted had similar characteristics except history of lung disease. <h3>Conclusion</h3> Our results suggest that both low offer and acceptance rates contribute to lung non-utilization in pBDD. Identification of factors contributing to the non-utilization of pBDD lungs is required to expand the pediatric lung donor pool.