ABSTRACT
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 endpoints 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.
Key words
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© Published by Elsevier Inc. on behalf of International Society for Heart and Lung Transplantation.
