The Journal of Heart and Lung Transplantation
International Society for Heart and Lung Transplantation.

Differential donor management of pediatric vs adult organ donors and potential impact on pediatric lung transplantation

  • David R. Spielberg
    Section of Pediatric Pulmonology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas

    Division of Pulmonary and Sleep Medicine, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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  • Ernestina Melicoff
    Section of Pediatric Pulmonology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
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  • Jeffrey S. Heinle
    Division of Congenital Heart Surgery, Texas Children's Hospital; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
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  • Kathleen Hosek
    Department of Quality Assurance, Texas Children's Hospital, Houston, Texas
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  • George B. Mallory
    Reprint requests: George B. Mallory, MD, Department of Pediatrics, Section of Pediatric Pulmonology, Baylor College of Medicine, Texas Children's Hospital, 6701 Fannin Street, Suite 1040, Houston, TX 77030. Telephone: 832-822-3300. Fax: 832-825-3308.
    Section of Pediatric Pulmonology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
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Published:November 15, 2022DOI:


      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.


      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.


      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.


      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.



      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)
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