Background
In Australia, increased organ donation and subsequent lung transplantation (LTx) rates
have followed enhanced donor identification, referral and management, as well as the
introduction of a donation after circulatory death (DCD) pathway. However, the number
of patients waiting for LTx still continues to exceed the number of lung donors and
the search for further suitable donors is critical.
Methods
All 2014–2018 Victorian DonateLife hospital deaths after intensive care unit (ICU)
admission were analysed retrospectively to quantify unrecognised lung donors using
current criteria, as well as novel time-extended (90 mins–24 hrs post-withdrawal)
DCD lung donors.
Results
Using standard lung donor eligibility criteria, we identified 473 potential lung donors
and a further 122 time-extended DCD potential lung donors among 3,538 patients meeting
general eligibility criteria. Detailed review of end-of-life discussions with patient
families and the reasons why they were not offered donation revealed several categories
of additional lung donors–traditional lung donors missed in current practice (n=2);
hepatitis C infected lung donors potentially treatable with direct-acting antivirals
(n=14), time-extended DCD lung donors (n=60); donor lungs potentially suitable for
transplant with use of ex-vivo lung perfusion (EVLP) (n=7).
Conclusion
While the number of lung donor opportunities missed under existing DonateLife donor
identification and management processes was limited, a time-extended DCD lung donation
pathway could substantially expand the lung donor pool. The use of hepatitis C infected
donors, and the possibility of EVLP to solve donor graft assessment or logistic issues,
could also provide small additional lung donor opportunities.
Keywords
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References
- Annual report.(Available at:)https://donatelife.gov.au/about-us/strategy-and-performance/annual-report-0Date accessed: August 1, 2020
- Review of the implementation of the national reform agenda on organ and tissue donation and transplantation 2017.(Available at:)https://www.health.gov.au/sites/default/files/response-review-of-organ-and-tissue-donation-and-transplantation.pdfDate accessed: August 1, 2020
- Donor risk prediction: how 'extended' is safe?.Curr Opin Organ Transplant. 2013; 18: 507-512
- Lung transplantation in Australia, 1986-2018: more than 30 years in the making.Med J Aust. 2018; 208: 445-450
- Donor lung referrals for lung transplantation: a 'behind the scenes' view.Heart Lung Circ. 2020; 29: 793-799
- Australian and New Zealand Intensive Care Society. ANZICS Statement on Death and Organ Donation, Edition 4. 2019
- Influence of lung donor agonal and warm ischemic times on early mortality: analyses from the ISHLT DCD Lung Transplant Registry.J Heart Lung Transplant. 2019; 38: 26-34
- Clinical Guidelines for Organ Transplantation from Deceased Donors (Version 1.3).2019
- Successful lung transplantation from a donation after cardiocirculatory death donor taking more than 120 minutes to cardiac arrest after withdrawal of life support therapies.J Heart Lung Transplant. 2016; 35: 258-259
- Estimating the number of organ donors in australian hospitals–implications for monitoring organ donation practices.Transplantation. 2015; 99: 2203-2209
- Guide to the quality and safety of Organs for Transplantation (7th Edition).2018
- Donation after brain death versus donation after circulatory death: lung donor management issues.Semin Respir Crit Care Med. 2018; 39: 138-147
- National protocol for Donation after Cardiac Death.2010 (Available at:)https://donatelife.gov.au/sites/default/files/DCD%20protocol%20020311-0e4e2c3d-2ef5-4dff-b7ef-af63d0bf6a8a-1.PDFDate accessed: August 1, 2020
- Heart and lung transplants from HCV-infected donors to uninfected recipients.N Engl J Med. 2019; 380: 1606-1617
- Successful lung transplantation from hepatitis C positive donor to seronegative recipient.Am J Transplant. 2017; 17: 1129-1131
- Untapped potential in Australian hospitals for organ donation after circulatory death.Med J Aust. 2017; 207: 294-301
- International Registry of Organ Donation and Transplantation Newsletter 2017.(Available at:)http://www.irodat.org/img/database/pdf/IRODaT%20Newsletter%202017.pdfDate accessed: August 1, 2020
- OPTN/SRTR 2017 Annual data report.(Available at:)https://srtr.transplant.hrsa.gov/annual_reports/Default.aspxDate accessed: August 1, 2020
- Continued successful evolution of extended criteria donor lungs for transplantation.Ann Thorac Surg. 2017; 104: 1702-1709
- Normothermic ex vivo lung perfusion in clinical lung transplantation.N Engl J Med. 2011; 364: 1431-1440
- Ex vivo lung perfusion prior to transplantation: an overview of current clinical practice worldwide.J Thorac Dis. 2019; 11: 1635-1650
- Normothermic ex vivo lung perfusion: does the indication impact organ utilization and patient outcomes after transplantation?.J Thorac Cardiovasc Surg. 2020; 159: 346-355
Article info
Publication history
Published online: June 25, 2021
Accepted:
May 15,
2021
Received in revised form:
May 3,
2021
Received:
September 22,
2020
Identification
Copyright
© 2021 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
