The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation · 2026
Lung Utilization and Transplant Outcomes after Donor Management at an In-Hospital Donor Care Unit versus the Donor Hospital.
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Stewart Darren E, Sommer Philip M, Victoria Davis N P, Chang Stephanie H, Natalini Jake G, Piper Greta L, Mehta Sapna A, McBride Jennifer P, Boulton Gabriella C, Lesko Melissa B, Massie Allan B, Segev Dorry L, Montgomery Robert A, Angel Luis F
Аннотация
BACKGROUND: Fewer than 20% of donated lungs are transplanted. We examined the impacts of donor management and recovery at an in-hospital donor care unit (DCU) established in 2021 versus the donor hospital (DH).
METHODS: Using Organ Procurement & Transplantation Network data on donors recovered March 2021 to December 2024, we compared lung utilization and post-transplant outcomes after donor management in the DCU (n=334) versus the donor hospital (DH, n=399), adjusting for donor factors with propensity weighting. Secondary outcomes included heart, liver, and kidney utilization. Changes in donor PaO2/FiO2 (P/F ratio) were examined as a hypothesized effect modifier. We projected the national impact of improved utilization on lung transplant volume.
RESULTS: After adjusting for donor differences, lung utilization was 88% higher (aRR: 1.88; 95% CI: 1.40, 2.53) in the DCU versus DH setting. Median P/F ratio increased from 275 to 348 mmHg (p<0.0001) in the DCU and explained approximately 38% of the improvement in lung utilization. Non-lung organ utilization was either improved or non-inferior in the DCU. Lung graft survival and pulmonary function were similar for recipients of DCU versus DH-managed donors. Nationally, an 88% improvement in lung utilization among donors not currently transferred to a DCU could theoretically result in ≥300 more lung transplants per year.
CONCLUSIONS: Lung transplantation can be nearly doubled through lung-centric donor management in a DCU, without sacrificing recipient outcomes nor the utilization of other organs. Donor management practices to optimize lung utilization should be proliferated by establishing more DCUs and, where feasible, applying lung-centric protocols in donor hospitals.
METHODS: Using Organ Procurement & Transplantation Network data on donors recovered March 2021 to December 2024, we compared lung utilization and post-transplant outcomes after donor management in the DCU (n=334) versus the donor hospital (DH, n=399), adjusting for donor factors with propensity weighting. Secondary outcomes included heart, liver, and kidney utilization. Changes in donor PaO2/FiO2 (P/F ratio) were examined as a hypothesized effect modifier. We projected the national impact of improved utilization on lung transplant volume.
RESULTS: After adjusting for donor differences, lung utilization was 88% higher (aRR: 1.88; 95% CI: 1.40, 2.53) in the DCU versus DH setting. Median P/F ratio increased from 275 to 348 mmHg (p<0.0001) in the DCU and explained approximately 38% of the improvement in lung utilization. Non-lung organ utilization was either improved or non-inferior in the DCU. Lung graft survival and pulmonary function were similar for recipients of DCU versus DH-managed donors. Nationally, an 88% improvement in lung utilization among donors not currently transferred to a DCU could theoretically result in ≥300 more lung transplants per year.
CONCLUSIONS: Lung transplantation can be nearly doubled through lung-centric donor management in a DCU, without sacrificing recipient outcomes nor the utilization of other organs. Donor management practices to optimize lung utilization should be proliferated by establishing more DCUs and, where feasible, applying lung-centric protocols in donor hospitals.