Predictors of nonuse of donation after circulatory death lung allografts |
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| Authors: | Ashley Y Choi Oliver K Jawitz Vignesh Raman Michael S Mulvihill Samantha E Halpern Yaron D Barac Jacob A Klapper Matthew G Hartwig |
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| Institution: | 1. School of Medicine, Duke University, Durham, NC;2. Department of Surgery, Duke University Medical Center, Durham, NC;3. The Division of Cardiovascular and Thoracic Surgery, Rabin Medical Center, Petach-Tikva, Israel;1. Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn;2. Hartford Hospital, Hartford, Conn;3. Department of Cardiovascular and Endovascular Surgery, Kazan State Medical University, Kazan, Russia;1. Section of Cardiothoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Conn;2. Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY;1. Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, Kentucky;3. Division of Cardiovascular Medicine, University of Louisville, Louisville, Kentucky;2. Center for Advanced Heart Failure and Department of Cardiothoracic and Vascular Surgery, University of Texas – Houston McGovern Medical School, Houston, Texas |
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| Abstract: | ObjectiveDespite growing evidence of comparable outcomes in recipients of donation after circulatory death and donation after brain death donor lungs, donation after circulatory death allografts continue to be underused nationally. We examined predictors of nonuse.MethodsAll donors who donated at least 1 organ for transplantation between 2005 and 2019 were identified in the United Network for Organ Sharing registry and stratified by donation type. The primary outcome of interest was use of pulmonary allografts. Organ disposition and refusal reasons were evaluated. Multivariable regression modeling was used to assess the relationship between donor factors and use.ResultsA total of 15,458 donation after circulatory death donors met inclusion criteria. Of 30,916 lungs, 3.7% (1158) were used for transplantation and 72.8% were discarded primarily due to poor organ function. Consent was not requested in 8.4% of donation after circulatory death offers with donation after circulatory death being the leading reason (73.4%). Nonuse was associated with smoking history (P < .001), clinical infection with a blood source (12% vs 7.4%, P = .001), and lower PaO2/FiO2 ratio (median 230 vs 423, P < .001). In multivariable regression, those with PaO2/FiO2 ratio less than 250 were least likely to be transplanted (adjusted odds ratio, 0.03; P < .001), followed by cigarette use (0.28, P < .001), and donor age >50 (0.75, P = .031). Recent transplant era was associated with significantly increased use (adjusted odds ratio, 2.28; P < .001).ConclusionsNontransplantation of donation after circulatory death lungs was associated with potentially modifiable predonation factors, including organ procurement organizations' consenting behavior, and donor factors, including hypoxemia. Interventions to increase consent and standardize donation after circulatory death donor management, including selective use of ex vivo lung perfusion in the setting of hypoxemia, may increase use and the donor pool. |
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