Background
Despite clinical progress over time, a shortage of suitable donor organs continues
to limit solid organ transplantation around the world. Lungs are the organs most likely
to be assessed as unsuitable during donor management among all transplantable organs.
Although the number of lung transplants performed in children is limited, death on
the wait list remains a barrier to transplant success for many potential transplant
candidates. Optimizing organ donor management can yield additional organs for transplant
candidates.
Methodology
We accessed the Donor Management Goal (DMG) Registry to evaluate the efficiency and
efficacy of donor management in the procurement of lungs for transplantation. Further,
we stratified donors by age and compared pediatric age cohorts to adult cohorts with
respect to attainment of donor management target goals and successful pathway to transplantation.
We utilized recipient data from the Organ Procurement Transplantation Network (OPTN)
to put this data into context. The DMG bundle consists of nine physiologic parameters
chosen as end-points guiding donor management for potential organ donors. The number
of parameters fulfilled has been regarded as an indication of efficacy of donor management.
Results
We noted a markedly lower number of organ donors in the pediatric age group compared
to adults. On the other hand, the number of donors greatly exceeds the number of infants,
children and adolescents who undergo lung transplantation. Organs transplanted per
donor peaks in the adolescent age group. At initial donor referral, DMG bundle attainment
is lower in all age groups and improves during donor management. With respect to oxygenation,
there is less overall improvement in younger donors compared to older donors during
donor management. When donors who yield lungs for transplantation are compared to
those whose lungs were not transplanted, oxygenation improved more substantially during
donor management. Furthermore, improved oxygenation correlated with the total number
of organs transplanted per donor.
Conclusions
In the face of continued wait list mortality on the pediatric lung transplant wait
list, the number of young donors may not be a limiting factor. We believe that this
dataset provides evidence that management of young pediatric donors is not as consistent
or efficient as the management of older donors, potentially limiting the number of
life-saving organs for pediatric lung transplant candidates. Across all ages, optimizing
donor lung management may increase the potential to transplant multiple other organs.
KEYWORDS
Abbreviations:
OPTN (Organ Procurement and Transplantation Network), DMG (Donor Management Goals), UNOS (United Organ for Organ Sharing), DTCP (Donation and Transplantation Community of Practice), HRSA (Human Resources and Services Administration), P:F (ratio of the pressure of arterial oxygen to fraction of inspired oxygen), OPO (organ procurement organization), OTPD (organs transplanted per donor)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: November 15, 2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 International Society for Heart and Lung Transplantation. All rights reserved.
