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

Differential Donor Management of Pediatric versus Adult Organ Donors and Potential Impact on Pediatric Lung Transplantation

Published:November 15, 2022DOI:https://doi.org/10.1016/j.healun.2022.11.003

      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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      Bibliography

      1. https://unos.org/data/transplant-trends/accessed April 7, 2021 and June 13, 2022.

        • Sweet SC
        • Barr ML.
        Pediatric lung allocation: the rest of the story.
        Am J Transplant. 2014; 14: 11-12
        • Patel MS
        • Sally M
        • Niemann CU
        • Malinoski DJ.
        State of the science in deceased organ donor management.
        Curr Transplant Rep. 2018; 5: 273-281
        • Franklin GA
        • Santos AP
        • Smith JW
        • Galbraith S
        • Harbrecht BG
        • Garrison RN.
        Optimization of donor management goals yields increased organ use.
        Am Surg. 2010; 76: 587-594
        • Patel MS
        • De La
        • Cruz S
        • Sally MB
        • Groat T
        • Malinoski DJ.
        Active donor management during the hospital phase of care is associated with more organs transplanted per donor.
        J Am Coll Surg. 2017; 225: 525-531
        • Ream RS
        • Clark MG
        • Arnbrecht ES.
        Pediatric donor management goals in use by US organ procurement organizations.
        Prog Transplant. 2019; 29: 150-157
        • Dowell S
        • Dawson A
        • McBride V.
        Engaging the third estate: the Transplant Growth and Management Collaborative.
        Prog Transplant. 2009; 19: 235-242
      2. https://dmginfo.nationaldmg.org/

        • Malinoski DJ
        • Daly MC
        • Patel MS
        • Oley-Graybill C
        • Foster CE
        • Salim A.
        Achieving donor mangement goals before deceased donor procurement is associated with more organs transplanted per donor.
        J Trauma. 2011; 71: 990-996
      3. Private communication from DJ Malinoski, medical director, DMG.

        • Patel MS
        • Zatarain J
        • De La
        • Cruz S
        • Sally MB
        • Ewing T
        • Crutchfield M
        • Enestvedt K
        • Malinoski DJ.
        The impact of meeting donor management goals on the number of organs transplanted per expanded criteria donor: a prospective study from the UNOS Region 5 Donor Managemment Goals Workgroup.
        J Am Coll Surg. 2017; 225: 525-531
        • Sally MB
        • Ellis MK
        • Hutchens M
        • Groat T
        • Swanson E
        • Patel MS
        • Niemann CU
        • Malinoski DJ.
        Deceased organ donor factors influencing pancreatic graft transplantation and survival.
        Clin Transplant. 2019; 33: e13571
        • Malinoski DJ
        • Patel MS
        • Ahmed O
        • Daly MC
        • Mooney S
        • Graybill CO
        • Foster CE
        • Salim A.
        The impact of meeting donor management goals on the development of delayed graft function in kidney transplant recipients.
        Am J Transplant. 2013; 13: 993-1000
        • Swanson EA
        • Adams T
        • Patel MS
        • De La Crux S
        • Hutchens M
        • Khush K
        • Sally M
        • Niemann CU
        • Groat T
        • Malinoski D.
        Impact of deceased donor management on donor heart use and recipient graft survival.
        J Am Coll Surg. 2020; 231: 351-360
        • Swanson EA
        • Patel MS
        • Hutchens MP
        • Neimann CU
        • Groat T
        • Malinoskis DJ
        • Sally MB.
        Critical care and ventilatory management of deceased organ donors impact lung use and recipient graft survival.
        Am J Transplant. 2021; 21: 4003-4011
        • Chang SH
        • Kreisel D
        • Marklin GF
        • Cook L
        • Hachem R
        • Kozower BD
        • Balsara KR
        • Bell JM
        • Frederiksen C
        • Meyers BF
        • Patterson GA
        • Puri V.
        Lung focused resuscitation at a specialized donor care facility improves lung procurement rates.
        Ann Thorac Surg. 2018; : 1531-1563
        • Minambres E
        • Perez_Viilares JM
        • Terceros-Almanza L.
        • Duenas-Jurado JM
        • Zabalegui A
        • Misis M
        • Bouza MT
        • Ballesteros MA
        • Coll E.
        An intensive lung donor treatment protocol does not have a negative influence on other grafts: a multicenter study.
        Eur J Cardiothorac Surg. 2016; 49: 1719-1724
        • Cantu E Courtwright A.
        Evaluation and management of the potential lung donor.
        Clin Chest Med. 2017; 38: 751-759
        • Bratton SL
        • Kolovos NS
        • Roach ES
        • McBride V
        • Geiger JL
        • Meyers RL.
        Pediatric organ transplantation needs organ donation best practices.
        Arch Pediatr Adolesc Med. 2006; 160: 468-472
        • Melicoff E
        • Heinle JS
        • McKenzie ED
        • Schrader AL
        • Hosek KE
        • Mallory GB.
        Improved outcomes with infants and young children undergoing lung transplantation at three years of age and younger.
        Ann Am Thorac Soc. 2022; (accepted for publication)
        • Khan MS
        • Heinle JS
        • Samayoa AX
        • Adachi I
        • Schecter MG
        • Mallory GB
        • Morales DL.
        Is lung transplantation survival better in infants?.
        J Heart Lung Transplant. 2013; 32: 44-49
        • Werner R
        • Benden C.
        Pediatric lung transplantation as standard of care.
        Clin Transplant. 2021; 35: e14126
        • Kinane TB
        • Lin AE
        • Lahoud-Rahme M
        • Westra SJ
        • Mark EJ.
        Case 4-2017. A 2-month-old girl with growth retardation and respiratory failure.
        N Engl J Med. 2017; 376: 562-574
        • Mallory GB
        • Schecter MG
        • Elidemir O.
        The management of the pediatric organ donor to optimize lung donation.
        Pediatr Pulmonol. 2009; 44: 536-546
        • Nakagawa TA
        • Shemie SD
        • Dryden-Palmer K
        • Parshuram CS
        • Brierly J.
        Organ donation folloing circulatory determination of death.
        Pediatr Crit Care. 2018; 19: S26-S32
        • Kotloff RM
        • Blosser S
        • Fulda GJ
        • Malinoski D
        • Ahya VN
        • Angel L
        • Byrnes MC
        • DeVita MA
        • Grisson TE
        • Halpern SD
        • Nakagawa TA
        Management of the potential organ donor in the ICU.
        Crit Care Med. 2015; 43: 1291-1325
        • Ream RS
        • Armbrecht ES.
        Variation in pediatric organ donor management practices among US organ procurement organizations.
        Prog Transplant. 2018; 28: 4-11
        • Shafer TJ
        • Schradke LL
        • Evans RW
        • O'Connor KJ
        • Reitsma W
        Vital role of medical examiners and coroners in organ transplantation.
        Am J Transplant. 2003; 4: 160-168
        • Cypel M
        • Yeung JC
        • Hirayama S
        • Rubacha M
        • Fischer S
        • Anraku M
        • Sato M
        • Harwood S
        • Pierre A
        • Waddell TK
        • de Perrot M
        • Keshavjee S.
        Technique for prolonged normothermic ex vivo lung perfusion.
        J Heart Lung Transplant. 2008; 27: 1319-1325