W. Z. Chancellor1, E. J. Charles1, J. H. Mehaffey1, R. Hawkins1, C. Foster1, A. K. Sharma1, V. Laubach1, C. Lau1, I. L. Kron1, C. Tribble1 1University Of Virginia,Division Of Thoracic And Cardiovascular Surgery,Charlottesville, VA, USA
Introduction: The number of patients with end-stage pulmonary disease awaiting lung transplantation is at an all-time high while the supply of available organs remains stagnant. Utilizing donation after circulatory death (DCD) donors may help to address the supply-demand mismatch. The objective of this study is to determine the potential for donor pool expansion with increased procurement of DCD organs from patients that die at hospitals.
Methods: A chart review of all patients who died at a single quaternary-care institution between August 2014 and June 2015 was performed. Data collected on each patient included cause of death, presence of lung pathology, arterial blood gas data, and chest radiograph findings within 7 days of death. Candidates for lung donation after circulatory death were those less than 65 years old, free of any cancer, without lung pathology, and did not die of respiratory causes or sepsis.
Results: 853 patients died over a one-year period and were stratified by age into three groups: <15 years old (6.0% n=51), 15 to 64 years old (38.0% n=324), and >65 years old (56.0% n=478). The number of patients less than 65 years old was 375 (44.0%), those without cancer totaled 778 (91.2%), and those without lung pathology at the time of death totaled 512 (59%). Based on the aforementioned criteria, 85 patients qualified as candidates for lung donation after circulatory death (Pediatric n=10, Young n=75, and Old n=0). Patients categorized as potential donors were significantly more likely to have clear chest X-ray findings (24.29% vs 9.96%, p=0.0006) and higher mean PaO2/FiO2 (342.1 vs 197.9, p<0.0001) compared to those screened as not eligible to be donors.
Conclusion: A significant number of DCD lungs are available every year from patients that die in hospitals. We estimate a potential 400% increase in lung donors with the use of DCD lungs per comparable-sized hospital per year based on average of 20 lung donors per hospital per year.
