Impact of donor care unit opening and use on lung donation from deceased organ donors after brain death.

BACKGROUND

Deceased donors after brain death (DBD) transferred to donor care units (DCUs) have higher rates of lung donation than donors remaining in hospitals, but contributions of regional DCU availability and donor transfer to lung donation remain unknown.

MATERIALS AND

METHODS

Cohort study using Organ Procurement & Transplantation Network (OPTN) deceased donor registry files, including adult DBDs managed in donation regions with operating DCUs, 2017-2024. Multivariable logistic regression and G-computation were used to test the hypothesis that individual donor transfer to DCU, rather than regional DCU availability, is associated with a higher likelihood of lung donation (primary outcome).

RESULTS

Among 27,795 DBDs managed by 28 OPOs, lung donation rate was 28.6% (7,958 donations). After adjustment for donor characteristics, predicted lung donation rates were similar before (29.1%, 95% CI 27.9-30.2) and after (28.9%, 95% CI 28.3-29.6) regional DCU adoption. Despite wide variation in regional transfer rates (5.2-96.7%), greater regional transfer was not associated with lung donation. After adjustment for donor factors, organ recovery year, and organ procurement organization, donor transfer to DCUs (vs. hospitals) remained associated with higher odds of lung donation overall (aOR 1.32, 95% CI 1.20-1.46) and for each DCU type (independent (aOR 1.41, 95% CI 1.21-1.65) and hospital-based (aOR 1.27, 95% CI 1.12-1.44)).

CONCLUSIONS

Superior lung donation rates were seen only for donors transferred from regional hospitals to DCUs. There was no observable association between the proportion of donors transferred and lung donation, suggesting that superior donation outcomes may reflect the selection of donors for transfer rather than system-wide effects of DCU availability.