Gregory I Snell1, Anne Griffiths, Bronwyn J Levvey, Takahiro Oto. 1. Lung Transplant Service, Department of Allergy, Immunology and Respiratory Medicine, The Alfred Hospital and Monash University, Melbourne, Victoria, Australia. g.snell@alfred.org.au
Abstract
BACKGROUND: It is important to utilize all lung donor offers to maximize lung transplant (LTx) opportunities. METHODS: This report describes the results of strategies that have evolved to evaluate and optimize cadaveric donor lung function and intra- and post-operative ICU management. Ongoing interactions between the intensive care unit (ICU) staff, donor coordinators and the LTx team all contribute to this process. Data are compared with the annual reports of the 2005 USA Organ and Transplant Procurement Network and UK Transplant. RESULTS: In 2001, 41% of all local (State of Victoria) multiple-organ donors referred for LTx were transplanted at the Alfred Hospital, with 36% considered functionally unusable. In 2006, 66% of Victorian donors contributed lungs for LTx (18% functionally unusable, 16% logistically unusable). Of the interstate (rest of Australia) lung donor offers, 50% (no local LTx unit present) and 32% (local LTx unit with first offer) were utilized, with 33% and 48% functionally unusable, respectively. Of the 47 resultant Alfred Hospital LTxs in 2006, survival rates were 100% at 180 days and 96% at 365 days, with no mortality directly attributable to donor quality. Overall, 54% (91 of 163) of Australian organ donor offers were used for LTx (i.e., 4.5 per million population [PMP]), compared with 17% in the USA (3.8 PMP) and 13% in the UK (2.0 LTx donors PMP) in 2005. CONCLUSIONS: A strategy of peri-operative lung donor evaluation and intervention suggests the number of truly unusable donor lungs is only a small fraction of the overall donor pool. In Australia, this strategy makes a significant difference in lung retrieval and transplantation rates, despite an intrinsically low (10 PMP) national donor rate.
BACKGROUND: It is important to utilize all lung donor offers to maximize lung transplant (LTx) opportunities. METHODS: This report describes the results of strategies that have evolved to evaluate and optimize cadaveric donor lung function and intra- and post-operative ICU management. Ongoing interactions between the intensive care unit (ICU) staff, donor coordinators and the LTx team all contribute to this process. Data are compared with the annual reports of the 2005 USA Organ and Transplant Procurement Network and UK Transplant. RESULTS: In 2001, 41% of all local (State of Victoria) multiple-organ donors referred for LTx were transplanted at the Alfred Hospital, with 36% considered functionally unusable. In 2006, 66% of Victorian donors contributed lungs for LTx (18% functionally unusable, 16% logistically unusable). Of the interstate (rest of Australia) lung donor offers, 50% (no local LTx unit present) and 32% (local LTx unit with first offer) were utilized, with 33% and 48% functionally unusable, respectively. Of the 47 resultant Alfred Hospital LTxs in 2006, survival rates were 100% at 180 days and 96% at 365 days, with no mortality directly attributable to donor quality. Overall, 54% (91 of 163) of Australian organ donor offers were used for LTx (i.e., 4.5 per million population [PMP]), compared with 17% in the USA (3.8 PMP) and 13% in the UK (2.0 LTx donors PMP) in 2005. CONCLUSIONS: A strategy of peri-operative lung donor evaluation and intervention suggests the number of truly unusable donor lungs is only a small fraction of the overall donor pool. In Australia, this strategy makes a significant difference in lung retrieval and transplantation rates, despite an intrinsically low (10 PMP) national donor rate.
Authors: Chandima Divithotawela; Marcelo Cypel; Tereza Martinu; Lianne G Singer; Matthew Binnie; Chung-Wai Chow; Cecilia Chaparro; Thomas K Waddell; Marc de Perrot; Andrew Pierre; Kazuhiro Yasufuku; Jonathan C Yeung; Laura Donahoe; Shaf Keshavjee; Jussi M Tikkanen Journal: JAMA Surg Date: 2019-12-01 Impact factor: 14.766
Authors: M R Baldwin; E R Peterson; I Easthausen; I Quintanilla; E Colago; J R Sonett; F D'Ovidio; J Costa; J M Diamond; J D Christie; S M Arcasoy; D J Lederer Journal: Am J Transplant Date: 2013-08-26 Impact factor: 8.086
Authors: Oliver K Jawitz; Vignesh Raman; David Becerra; Julie Doberne; Ashley Y Choi; Samantha E Halpern; Jacob A Klapper; Matthew G Hartwig Journal: Ann Surg Date: 2020-07-24 Impact factor: 13.787