A narrative review of the impact of donor factors and selection criteria on outcomes after lung transplantation

Abstract

Objective: The purpose of this review is to critically evaluate lung donor selection criteria and assess their impact on outcomes after lung transplantation.Background: Lung transplantation remains the most effective therapy for end stage pulmonary disease.Selection of a suitable donor is essential for a successful recipient outcome. Both physiological and physical characteristics of the donor organ factor into decision making for proceeding with a transplant. Donor medical history may also be important when assessing potential offers.Methods: A contemporary literature review of lung donor variables and their impact on outcomes after lung transplantation was performed using Ovid and PubMed search engines. The relative importance of each factor on decision making was evaluated based on the available evidence from identified reference sources.Conclusions: Donor acceptance criteria typically involve acceptable gas exchange, size match, radiographic appearance, bronchoscopic inspection, limited smoking history and finally intraoperative surgical evaluation.Donor age, human leukocyte antigen (HLA) mismatches, serology and comorbidities such as hypertension and diabetes mellitus may be equally if not more important risk factors affecting recipient survival.Additionally, certain recipient variables should be considered when evaluating an organ offer. Donor type, brain dead or donation after determination of circulatory death, does not seem to significantly affect outcomes after lung transplantation.