Abstract
Lung transplantation (LTx) has traditionally been limited by a lack of suitable donor
lungs. With the recognition that lungs are more robust than initially thought, the
size of the donor pool of available lungs has increased dramatically in the past decade.
Donation after brain death (DBD) and donation after circulatory death (DCD) lungs,
both ideal and extended are now routinely utilized. DBD lungs can be damaged. There
are important differences in the public's understanding, legal and consent processes,
intensive care unit strategies, lung pathophysiology, logistics, and potential-to-actual
donor conversion rates between DBD and DCD. Notwithstanding, the short- and long-term
outcomes of LTx from any of these DBD versus DCD donor scenarios are now similar,
robust, and continue to improve. Large audits suggest there remains a large untapped
pool of DCD (but not DBD) lungs that may yet further dramatically increase lung transplant
numbers. Donor scoring systems that might predict the donor conversion rates and lung
quality, the role of ex vivo lung perfusion as an assessment and lung resuscitation
tool, as well as the potential of donor lung quality biomarkers all have immense promise
for the clinical field.
Keywords
lung transplantation - organ donation - donor management - donation after brain death
- donation after circulatory death
