Histopathologic and radiologic assessment of nontransplanted donor lungs

Donor organ shortage results in significant waiting list mortality. Donor lung assessment is currently based on donors’ history, gas exchange, chest X‐ray, bronchoscopy findings, and ultimately in situ inspection but remains subjective. We correlated histopathology and radiology in nontransplanted donor lungs with the clinical indications to decline the offered organ. Sixty‐two donor lungs, not used for transplantation (2010‐2019), were procured, air‐inflated, frozen, scanned with computed tomography, systematically sampled, and histologically and radiologically assessed. Thirty‐nine (63%) lungs were declined for allograft‐related reasons. In 13/39 (33%) lungs, histology could not confirm the reason for decline, in an additional 8/39 (21%) lungs, histologic abnormalities were only considered mild. In 16/39 (41%) lungs, radiology could not confirm the reason for decline. Twenty‐three (37%) donor lungs were not transplanted due to extrapulmonary causes, of which three (13%) lungs displayed severe histologic abnormalities (pneumonia, n = 2; emphysema, n = 1), in addition to mild emphysema in 9 (39%) lungs and minor bronchopneumonia in 1 (4%). Radiology revealed ground‐glass opacities in 8/23 (35%) and emphysema in 4/23 (17%) lungs. Histopathologic and radiologic assessment of nontransplanted donor lungs revealed substantial discrepancy with the clinical reason for decline. Optimization of donor lung assessment is necessary to improve current organ acceptance rates.