The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation · 2026
Donor disposition and lung utilization following "Not Expected to Progress" coding in donation after circulatory death: A national registry analysis.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
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Jafari Brian, Spinetta Lauryn, Kaza Vaidehi, Peltz Matthias, Heid Christopher, Murala John, Keshavamurthy Suresh
Аннотация
BACKGROUND: Donation-after-circulatory-death (DCD) lung transplantation expands access for waitlisted patients, but uncertainty regarding donor progression may lead centers to decline offers using refusal code 753 ("DCD donor neurological function/not expected to arrest"). We sought to characterize the disposition of these donors and center practices in their allocation.
METHODS: Using national registry match-run data from January 2021 through June 2024 linked with Organ Procurement and Transplant Network (OPTN) transplant data, we identified DCD donors from whom lung offers were generated. Donors declined at least once with code 753 were classified as not expected to progress (NEP). Donor progression, organ procurement, and post-transplant survival were compared with standard DCD (S-DCD) donors.
RESULTS: Among 6,140 NEP donors, 3,687 (60.0%) progressed to circulatory death and had at least one organ procured. Among progressed NEP donors, lungs were recovered from 908 donors (24.6%), and 670 donors ultimately yielded at least one transplanted lung. Post-transplant survival did not differ between linked recipients of NEP and S-DCD lungs (log-rank p = 0.15).
CONCLUSIONS: Many DCD donors declined using code 753 ultimately progressed after withdrawal of life-sustaining therapy, with lungs recovered in only a minority of these cases. The uncertainty surrounding donor progression may restrict access to DCD lung transplantation for waitlisted patients. Standardized DCD assessment, donor management, and policy guidance may help centers manage uncertainty when fielding DCD offers.
METHODS: Using national registry match-run data from January 2021 through June 2024 linked with Organ Procurement and Transplant Network (OPTN) transplant data, we identified DCD donors from whom lung offers were generated. Donors declined at least once with code 753 were classified as not expected to progress (NEP). Donor progression, organ procurement, and post-transplant survival were compared with standard DCD (S-DCD) donors.
RESULTS: Among 6,140 NEP donors, 3,687 (60.0%) progressed to circulatory death and had at least one organ procured. Among progressed NEP donors, lungs were recovered from 908 donors (24.6%), and 670 donors ultimately yielded at least one transplanted lung. Post-transplant survival did not differ between linked recipients of NEP and S-DCD lungs (log-rank p = 0.15).
CONCLUSIONS: Many DCD donors declined using code 753 ultimately progressed after withdrawal of life-sustaining therapy, with lungs recovered in only a minority of these cases. The uncertainty surrounding donor progression may restrict access to DCD lung transplantation for waitlisted patients. Standardized DCD assessment, donor management, and policy guidance may help centers manage uncertainty when fielding DCD offers.