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. 2016 Apr;16(4):1207-15.
doi: 10.1111/ajt.13599. Epub 2016 Feb 4.

Lung Quality and Utilization in Controlled Donation After Circulatory Determination of Death Within the United States

J J Mooney  1 , H Hedlin  1 , P K Mohabir  1 , R Vazquez  2 , J Nguyen  3 , R Ha  4 , P Chiu  4 , K Patel  1 , M R Zamora  5 , D Weill  1 , M R Nicolls  1 , G S Dhillon  1
Affiliations

Lung Quality and Utilization in Controlled Donation After Circulatory Determination of Death Within the United States

J J Mooney et al. Am J Transplant. 2016 Apr.

Abstract

Although controlled donation after circulatory determination of death (cDCDD) could increase the supply of donor lungs within the United States, the yield of lungs from cDCDD donors remains low compared with donation after neurologic determination of death (DNDD). To explore the reason for low lung yield from cDCDD donors, Scientific Registry of Transplant Recipient data were used to assess the impact of donor lung quality on cDCDD lung utilization by fitting a logistic regression model. The relationship between center volume and cDCDD use was assessed, and the distance between center and donor hospital was calculated by cDCDD status. Recipient survival was compared using a multivariable Cox regression model. Lung utilization was 2.1% for cDCDD donors and 21.4% for DNDD donors. Being a cDCDD donor decreased lung donation (adjusted odds ratio 0.101, 95% confidence interval [CI] 0.085-0.120). A minority of centers have performed cDCDD transplant, with higher volume centers generally performing more cDCDD transplants. There was no difference in center-to-donor distance or recipient survival (adjusted hazard ratio 1.03, 95% CI 0.78-1.37) between cDCDD and DNDD transplants. cDCDD lungs are underutilized compared with DNDD lungs after adjusting for lung quality. Increasing transplant center expertise and commitment to cDCDD lung procurement is needed to improve utilization.

Keywords: Scientific Registry for Transplant Recipients (SRTR); clinical research; donation after circulatory death (DCD); donor evaluation; donors and donation; dysfunction; lung (allograft) function; lung transplantation; organ procurement; organ procurement and allocation; practice; pulmonology.

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Conflict of interest statement

The authors of this manuscript have no conflicts of interest to disclose as described by the American Journal of Transplantation.

Figures

Figure 1
Figure 1
Flow Diagram of Donors and Recipients.
Figure 2
Figure 2. Lung Utilization over Time by cDCDD Status
The proportion of donation after neurological determination of death (DNDD) lungs (dashed line) and controlled donation after circulatory determination of death (cDCDD) lungs (solid line) utilized by year.
Figure 3
Figure 3. Total Lung Transplant and cDCDD Lung Transplant Volume by OPO and Transplant Center
Scatterplot with linear regression line of total lung transplant volume and controlled donation after circulatory determination of death (cDCDD) lung transplant volume. Each marker represents an organ procurement organization (OPO) (left panel) or lung transplant center (right panel).
Figure 4
Figure 4. Recipient Survival by cDCDD Status
Kaplan-Meier survival curve for post-transplant recipient survival in controlled donation after circulatory determination of death (cDCDD) recipients (dashed line) and donation after neurological determination of death (DNDD) recipients (solid line).
See this image and copyright information in PMC

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References

    1. Valapour M, Skeans MA, Heubner BM, Smith JM, Schnitzler MA, Hertz MI, et al. OPTN/SRTR 2012 Annual Data Report: lung. American journal of transplantation: official journal of the American Society of Transplantation and the American Society of Transplant Surgeons. 2014;14(Suppl 1):139–65. - PubMed
    1. Yusen RD, Shearon TH, Qian Y, Kotloff R, Barr ML, Sweet S, et al. Lung transplantation in the United States, 1999–2008. American journal of transplantation: official journal of the American Society of Transplantation and the American Society of Transplant Surgeons. 2010;10(4 Pt 2):1047–68. - PubMed
    1. Wigfield CH, Love RB. Donation after cardiac death lung transplantation outcomes. Current opinion in organ transplantation. 2011;16(5):462–8. - PubMed
    1. Cypel M, Keshavjee S. Strategies for safe donor expansion: donor management, donations after cardiac death, ex-vivo lung perfusion. Current opinion in organ transplantation. 2013 - PubMed
    1. Wigfield C. Donation after cardiac death for lung transplantation: a review of current clinical practice. Current opinion in organ transplantation. 2014;19(5):455–9. - PubMed

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