Lung transplantation: Deceased donor evaluation
- Edward R Garrity, MD, MBA
Edward R Garrity, MD, MBA
- Professor of Medicine
- University of Chicago
- Remzi Bag, MD
Remzi Bag, MD
- Associate Professor of Medicine
- The University of Chicago Medicine
Optimal selection and care of donor lungs for transplant are needed to increase the number of available lungs. Deceased donor evaluation, selection, and management after brain and cardiac death will be reviewed here from the lung transplant perspective. Living donor lobar transplants are rare in comparison to deceased donor lung transplants.
The indications for lung transplantation, selection of lung transplant recipients, and donor lung preservation are discussed separately. (See "Lung transplantation: An overview" and "Lung transplantation: General guidelines for recipient selection" and "Lung transplantation: Donor lung preservation" and "Management of the deceased organ donor".)
DONATION AFTER BRAIN DEATH
Donor evaluation begins with the notification of the local organ procurement organization (OPO) of a potential donor. A member of the OPO, or a provider trained in the consent of families for organ donation, should approach the family as soon as reasonable after the determination of brain death . (See "Diagnosis of brain death".)
When the patient has signed an irrevocable consent for transplant (offered through some state registries), the OPO staff will support the family through the organ retrieval and grieving process. If consent has not already been provided by the patient, the OPO staff will explain the procurement process to the family, including the dignity of the process and implications for funeral arrangements, and obtain their consent . The OPO staff will also coordinate evaluation of the donor for suitability for transplant and will communicate with the United Network for Organ Sharing (UNOS) to match the donor with an appropriate recipient from the waiting list. (See "Lung transplantation: An overview".)
DONATION AFTER CIRCULATORY DETERMINATION OF DEATH
Some experts recommend that the phrase "donation after circulatory determination of death" (DCDD) replace "donation after cardiac death" or "nonbeating heart donation." These experts emphasize that organ donation occurs after cessation of circulatory and respiratory, not cardiac, function . There is no official consensus to change this terminology, however.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Wijdicks EF. The diagnosis of brain death. N Engl J Med 2001; 344:1215.
- Medicare and Medicaid Programs; Conditions for Coverage for Organ Procurement Organizations (OPOs); Final Rule. Services, DoHaH (Ed), Federal Register May 31, 2006.
- Bernat JL, Capron AM, Bleck TP, et al. The circulatory-respiratory determination of death in organ donation. Crit Care Med 2010; 38:963.
- Kootstra G. Statement on non-heart-beating donor programs. Transplant Proc 1995; 27:2965.
- www.unos.org/SharedContentDocuments/Policy-Notice-March-2007-BOD-Meeting(a)(1).pdf - 2008-03-18 (Accessed on January 01, 2009).
- Steen S, Sjöberg T, Pierre L, et al. Transplantation of lungs from a non-heart-beating donor. Lancet 2001; 357:825.
- Gries CJ, White DB, Truog RD, et al. An official American Thoracic Society/International Society for Heart and Lung Transplantation/Society of Critical Care Medicine/Association of Organ and Procurement Organizations/United Network of Organ Sharing Statement: ethical and policy considerations in organ donation after circulatory determination of death. Am J Respir Crit Care Med 2013; 188:103.
- Cypel M, Levvey B, Van Raemdonck D, et al. International Society for Heart and Lung Transplantation Donation After Circulatory Death Registry Report. J Heart Lung Transplant 2015; 34:1278.
- Valapour M, Skeans MA, Smith JM, et al. Lung. Am J Transplant 2016; 16 Suppl 2:141.
- Bernat JL, D'Alessandro AM, Port FK, et al. Report of a National Conference on Donation after cardiac death. Am J Transplant 2006; 6:281.
- Ethics Committee, American College of Critical Care Medicine, Society of Critical Care Medicine. Recommendations for nonheartbeating organ donation. A position paper by the Ethics Committee, American College of Critical Care Medicine, Society of Critical Care Medicine. Crit Care Med 2001; 29:1826.
- Guidelines for the determination of death. Report of the medical consultants on the diagnosis of death to the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. JAMA 1981; 246:2184.
- Robertson JA. The dead donor rule. Hastings Cent Rep 1999; 29:6.
- Krutsinger D, Reed RM, Blevins A, et al. Lung transplantation from donation after cardiocirculatory death: a systematic review and meta-analysis. J Heart Lung Transplant 2015; 34:675.
- Sabashnikov A, Patil NP, Popov AF, et al. Long-term results after lung transplantation using organs from circulatory death donors: a propensity score-matched analysis†. Eur J Cardiothorac Surg 2016; 49:46.
- Castleberry AW, Worni M, Osho AA, et al. Use of lung allografts from brain-dead donors after cardiopulmonary arrest and resuscitation. Am J Respir Crit Care Med 2013; 188:466.
- Eberlein M, Permutt S, Chahla MF, et al. Lung size mismatch in bilateral lung transplantation is associated with allograft function and bronchiolitis obliterans syndrome. Chest 2012; 141:451.
- Eberlein M, Reed RM, Permutt S, et al. Parameters of donor-recipient size mismatch and survival after bilateral lung transplantation. J Heart Lung Transplant 2012; 31:1207.
- Mason DP, Batizy LH, Wu J, et al. Matching donor to recipient in lung transplantation: How much does size matter? J Thorac Cardiovasc Surg 2009; 137:1234.
- Eberlein M, Reed RM, Bolukbas S, et al. Lung size mismatch and primary graft dysfunction after bilateral lung transplantation. J Heart Lung Transplant 2015; 34:233.
- Shigemura N, Bermudez C, Hattler BG, et al. Impact of graft volume reduction for oversized grafts after lung transplantation on outcome in recipients with end-stage restrictive pulmonary diseases. J Heart Lung Transplant 2009; 28:130.
- Kotloff RM, Blosser S, Fulda GJ, et al. Management of the Potential Organ Donor in the ICU: Society of Critical Care Medicine/American College of Chest Physicians/Association of Organ Procurement Organizations Consensus Statement. Crit Care Med 2015; 43:1291.
- Chaney J, Suzuki Y, Cantu E 3rd, van Berkel V. Lung donor selection criteria. J Thorac Dis 2014; 6:1032.
- Garrity ER Jr, Boettcher H, Gabbay E. Donor infection: an opinion on lung donor utilization. J Heart Lung Transplant 2005; 24:791.
- Rosendale JD, Chabalewski FL, McBride MA, et al. Increased transplanted organs from the use of a standardized donor management protocol. Am J Transplant 2002; 2:761.
- Whiting D, Banerji A, Ross D, et al. Liberalization of donor criteria in lung transplantation. Am Surg 2003; 69:909.
- D'Armini AM, Boffini M, Zanotti G, et al. "Twinning procedure" in lung transplantation: influence of graft ischemia on survival and incidence of complications. Transplant Proc 2004; 36:654.
- Aigner C, Winkler G, Jaksch P, et al. Extended donor criteria for lung transplantation--a clinical reality. Eur J Cardiothorac Surg 2005; 27:757.
- Lardinois D, Banysch M, Korom S, et al. Extended donor lungs: eleven years experience in a consecutive series. Eur J Cardiothorac Surg 2005; 27:762.
- Reyes KG, Mason DP, Thuita L, et al. Guidelines for donor lung selection: time for revision? Ann Thorac Surg 2010; 89:1756.
- Sommer W, Kühn C, Tudorache I, et al. Extended criteria donor lungs and clinical outcome: results of an alternative allocation algorithm. J Heart Lung Transplant 2013; 32:1065.
- Mulligan MJ, Sanchez PG, Evans CF, et al. The use of extended criteria donors decreases one-year survival in high-risk lung recipients: A review of the United Network of Organ Sharing Database. J Thorac Cardiovasc Surg 2016; 152:891.
- Orens JB, Boehler A, de Perrot M, et al. A review of lung transplant donor acceptability criteria. J Heart Lung Transplant 2003; 22:1183.
- Bhorade SM, Vigneswaran W, McCabe MA, Garrity ER. Liberalization of donor criteria may expand the donor pool without adverse consequence in lung transplantation. J Heart Lung Transplant 2000; 19:1199.
- Pierre AF, Sekine Y, Hutcheon MA, et al. Marginal donor lungs: a reassessment. J Thorac Cardiovasc Surg 2002; 123:421.
- Bittle GJ, Sanchez PG, Kon ZN, et al. The use of lung donors older than 55 years: a review of the United Network of Organ Sharing database. J Heart Lung Transplant 2013; 32:760.
- Sommer W, Ius F, Salman J, et al. Survival and spirometry outcomes after lung transplantation from donors aged 70 years and older. J Heart Lung Transplant 2015; 34:1325.
- Hayes D Jr, Black SM, Tobias JD, et al. Influence of donor and recipient age in lung transplantation. J Heart Lung Transplant 2015; 34:43.
- Baldwin MR, Peterson ER, Easthausen I, et al. Donor age and early graft failure after lung transplantation: a cohort study. Am J Transplant 2013; 13:2685.
- Salerno CT, Burdine J, Perry EH, et al. Donor-derived antibodies and hemolysis after ABO-compatible but nonidentical heart-lung and lung transplantation. Transplantation 1998; 65:261.
- Yu NC, Haug MT 3rd, Khan SU, et al. Does the donor-recipient ABO blood group compatibility status predict subsequent lung transplantation outcomes? J Heart Lung Transplant 1999; 18:764.
- Taghavi S, Jayarajan SN, Furuya Y, et al. Single Lung Transplantation with ABO Compatible Donors Results in Excellent Outcomes. J Heart Lung Transplant 2014.
- Taghavi S, Jayarajan SN, Furuya Y, et al. Single-lung transplantation with ABO-compatible donors results in excellent outcomes. J Heart Lung Transplant 2014; 33:822.
- Low M, Gregory G. Passenger lymphocyte syndrome after lung transplant. Blood 2012; 120:4122.
- Horlait G, Bulpa P, Evrard P. Passenger lymphocyte syndrome mimicking hemolytic uremic syndrome after lung transplantation. J Heart Lung Transplant 2013; 32:271.
- Angel LF, Levine DJ, Restrepo MI, et al. Impact of a lung transplantation donor-management protocol on lung donation and recipient outcomes. Am J Respir Crit Care Med 2006; 174:710.
- de Perrot M, Wigle DA, Pierre AF, et al. Bronchogenic carcinoma after solid organ transplantation. Ann Thorac Surg 2003; 75:367.
- Berman M, Goldsmith K, Jenkins D, et al. Comparison of outcomes from smoking and nonsmoking donors: thirteen-year experience. Ann Thorac Surg 2010; 90:1786.
- Bonser RS, Taylor R, Collett D, et al. Effect of donor smoking on survival after lung transplantation: a cohort study of a prospective registry. Lancet 2012; 380:747.
- Taghavi S, Jayarajan SN, Komaroff E, et al. Single-lung transplantation can be performed with acceptable outcomes using selected donors with heavy smoking history. J Heart Lung Transplant 2013; 32:1005.
- Taghavi S, Jayarajan S, Komaroff E, et al. Double-lung transplantation can be safely performed using donors with heavy smoking history. Ann Thorac Surg 2013; 95:1912.
- Healey PJ, Davis CL. Transmission of tumours by transplantation. Lancet 1998; 352:2.
- Fishman JA, Greenwald MA, Kuehnert MJ. Enhancing transplant safety: a new era in the microbiologic evaluation of organ donors? Am J Transplant 2007; 7:2652.
- Ridgeway AL, Warner GS, Phillips P, et al. Transmission of Mycobacterium tuberculosis to recipients of single lung transplants from the same donor. Am J Respir Crit Care Med 1996; 153:1166.
- Huprikar S, Danziger-Isakov L, Ahn J, et al. Solid organ transplantation from hepatitis B virus-positive donors: consensus guidelines for recipient management. Am J Transplant 2015; 15:1162.
- Shitrit AB, Kramer MR, Bakal I, et al. Lamivudine prophylaxis for hepatitis B virus infection after lung transplantation. Ann Thorac Surg 2006; 81:1851.
- Organ Procurement and Transplantation Network. Guidance for organ donation and transplantation professionals regarding the Zika virus https://optn.transplant.hrsa.gov/news/guidance-for-organ-donation-and-transplantation-professionals-regarding-the-zika-virus/. (Accessed on March 14, 2016).
- Silveira FP, Campos SV. The Zika epidemics and transplantation. J Heart Lung Transplant 2016; 35:560.
- Anraku M, Cameron MJ, Waddell TK, et al. Impact of human donor lung gene expression profiles on survival after lung transplantation: a case-control study. Am J Transplant 2008; 8:2140.
- Cypel M, Liu M, Rubacha M, et al. Functional repair of human donor lungs by IL-10 gene therapy. Sci Transl Med 2009; 1:4ra9.
- DONATION AFTER BRAIN DEATH
- DONATION AFTER CIRCULATORY DETERMINATION OF DEATH
- DONOR SELECTION
- Size matching
- Ideal donor criteria
- Expanded donor criteria
- - Advanced donor age
- - ABO compatibility
- - Abnormal chest radiograph
- - Cytomegalovirus antibodies
- - Low PaO2
- - Diabetes mellitus
- - Smoking
- - Malignancy
- - Donor infection
- Ex vivo lung perfusion
- Donor genetics
- SUMMARY AND RECOMMENDATIONS