Transplant physicians (TP) can increase the number of donor lungs by early involvement in donor identification, selection and management. Currently, many Organ Procurement Organizations (OPO) use standard criteria to exclude potential donors. We have established a “Physician Driven Protocol” (PDP) that includes donor evaluation, use of “extended” versus standard criteria, and aggressive donor management by the TP.
We reviewed charts of all potential lung donors for 18 months prior to (Group A) and subsequent to (Group B) the establishment of the PDP. The number of donors, lung transplants performed, the effects on waiting list time and outcomes were determined for both groups. A subgroup analysis of multi-organ donors performed before and after the start of the PDP evaluated the effect of the protocol on the initial consenting and placement of lung donors by the OPO.
There were 164 total organ donors in Group A and 188 donors in Group B. The number of lungs donated increased from 17 (10.4%) in Group A to 39 (20.7%) in Group B, an increase of 119%. The numbers of lungs transplanted was 30 (24 recipients) in Group A and 64 (50 recipients) in Group B. Extended donors increased from 33.3% to 60.9%. Mean waiting time on the transplant list decreased from 290 +/-179 days to 87 +/- 96 days. Donors not consented by the OPO decreased from 32% to 8% and placement was not attempted in 44% of consented patients, compared to 24% after PDP was initiated.CONCLUSIONS: A PDP can increase the number of donor lungs by aggressive involvement in donor selection and management, which allows use of lungs, previously considered unacceptable for transplantation and can significantly decrease the waiting time.IMPLICATIONS: An essential aspect of a PDP is the education of OPO and non-transplant physicians in this process.
D.J. Levine, None.