PURPOSE: The waiting list mortality for lung transplantation is unacceptably high. Donor shortage is the limiting factor and assessment of allograft adequacy depends on few surrogate markers and predominantly subjective clinical judgment. We analyzed organ procurement data sets of rejected donor offers.
METHODS: 241 rejected potential donors were reviewed (2004/5). Organ procurement data sets (OPDS) were evaluated for demographic data, clinical details, cause of death, presence of aspiration (Asp) and/or infection (Inf) as well as bronchoscopic findings (Bronch) and ventilatory oxygenation indices (OI) and reasons for rejection. Univariate and multivariate analysis was performed of factors assessing marginal allografts.
RESULTS: Median, (range): Age 42(776), BMI 25 (13-46), 19.8% > BMI 30, Causes of donor Death were: CVA 44.4%, SICP 9.2%, other 33.8%, unknown 12.6%. 56.3% were smokers at the time of death, prevalence of asthma 5.3% and drug abuse 19.9%. Baseline PO2 148 (31-379 mmHg) and PO2 challenge 417 (92-673 mmHg). Aspiration was confirmed in 8.6% and 52.3% received no bronchoscopy. Pulmonary parenchymal infection was present in 16.5% with 7.3% no specific evaluation available. Reasons cited for rejection were: quality of allograft 43.7%, size mismatch 11.3%, age of donor 11.9%, specific clinical concerns 12.6%, logistic factors 11.9% and DCD donors 3.9% and no reason stated in 4.4%. MVA.
CONCLUSION: The prevalence of clinical donor risk factors such as smoking history and aspiration or infection, may not correlate with oxygenation indices during allograft assessment. Rejection of lung donors was rarely dependent on FiO2 challenge alone. Bronchoscopic analysis is not readily available for more conclusive allograft evaluation. In absence of predictive surrogate markers, pattern recognition remains the mainstay of the decision process. We advocate a standardized prospective organ procurement evaluation to improve lung allograft retrieval rates.
CLINICAL IMPLICATIONS: Assessment of rejected extended criteria donors reveals that an increased rate of bronchoscopy may yield a higher donor allograft utilization rate. This is essential in order to reduce the disparity between lung transplant candidates on waiting lists and suitable donors made available.
DISCLOSURE: Christopher Wigfield, None.