Objective assessment of criteria for selection of donor lungs suitable for transplantation

Abstract

Background: Donor organ shortage severely limits lung transplantation as a therapeutic option, yet many potential donor lungs are deemed unsuitable by clinical selection criteria. Methods: Of 39 consecutive potential donor lungs, 14 were accepted and 25 excluded by clinical selection criteria. All were evaluated prospectively by clinical assessment, bronchoscopy, and bronchoalveolar lavage (BAL) to evaluate objectively the discrimination of pulmonary infection and injury. Results: Accepted donors were significantly younger than those excluded (mean (SD) age 36.7 (15.3) years v 49.5 (13.2) years; p = 0.009, unpaired t test) and were more likely to have suffered traumatic brain death (50% v 20%; p = 0.07, Fisher's exact test). Oxygenation (PaO 2 :FiO 2 ) was higher in accepted donors than in excluded donors (median (range) 63.2 (48-82.5) kPa v 43.1 (7.7-71.7) kPa; p = 0.0001, Mann-Whitney test). Positive formal BAL culture was more frequent in accepted donors (75%) than in those excluded (43%; p = 0.1, Fisher's exact test). There was no significant difference in the percentage and concentration of neutrophils in BAL fluid between accepted and excluded donors (median (range) 37.9 (0-96.9)% and 44.6 (0-1190)610 3 /ml v 36 (1-98.1)% and 46 (0.2-1457)610 3 /ml), nor in the BAL fluid concentration of tumour necrosis factor-a (140 (0-340) pg/ml v 160 (0-760) pg/ml) or interleukin 8 (810 (33-17 600) pg/ml v 540 (0-15 110) pg/ml). Conclusion: Current selection criteria are poor discriminators of pulmonary injury and infection and lead to the exclusion of potentially usable donor lungs.

Clinical grade allogeneic human mesenchymal stem cells restore alveolar fluid clearance in human lungs rejected for transplantation

“…Current selection criteria are poor discriminators of pulmonary injury and infection and lead to the exclusion of potentially usable donor lungs (38). We (38) and others (16) have reported that physiological parameters in the donor, combined with AFC, could increase the rate of successful organ usage.…”

An observational study of Donor Ex Vivo Lung Perfusion in UK lung transplantation: DEVELOP-UK

“…The internationally accepted selection criteria of the 'optimal donor' are primarily opinion based rather than evidence based, and their accuracy in determining the physiological status of the donor lung and predicting post-operative lung function is not optimal. 18 Fisher et al 19 have shown that current clinical donor lung assessment criteria are poor predictors of existing inflammation or infection in the donor lung, suggesting that many donor lungs deemed unusable may be unnecessarily excluded. Ware et al 20 evaluated 29 pairs of unusable lungs by physiological, microbiological and histological methods, and concluded that as many as 40% of these lungs would have been potentially suitable for transplantation.…”

Diretrizes para manutenção de múltiplos órgãos no potencial doador adulto falecido: parte II. Ventilação mecânica, controle endócrino metabólico e aspectos hematológicos e infecciosos

“…(8,88) Recommendation -Positive culture results or a clinical infection diagnosis should not lead to an absolute contra-indication of organ donation, nor should the deceased donor's maintenance be discontinued (D) (31) (B). (89,90) Strong Recommendation.…”

“…From the accepted donors, 75% had positive BAL cultures, and only 43% of the rejected donors had positive culture results (B). (89) Despite the severity of several microorganism infections, the literature reports on donors with Acinetobacter baumannii bacteremia and septic shock whose organs were successfully transplanted with preand post-transplant antibiotic therapy support, with no additional recipient morbidities (B). (90) When donor risk scores combined with receptor risk scores are analyzed for renal transplants, hepatitis C appears to be an independent rejection factor (B).…”