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Semin Respir Crit Care Med 2018; 39(02): 138-147
DOI: 10.1055/s-0037-1615820
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Donation after Brain Death versus Donation after Circulatory Death: Lung Donor Management Issues

Gregory I. Snell
1   Lung Transplant Service, Alfred Hospital, Monash University, Melbourne, Australia
,
Bronwyn J. Levvey
1   Lung Transplant Service, Alfred Hospital, Monash University, Melbourne, Australia
,
Kovi Levin
1   Lung Transplant Service, Alfred Hospital, Monash University, Melbourne, Australia
,
Miranda Paraskeva
1   Lung Transplant Service, Alfred Hospital, Monash University, Melbourne, Australia
,
Glen Westall
1   Lung Transplant Service, Alfred Hospital, Monash University, Melbourne, Australia
› Author Affiliations
Further Information

Publication History

Publication Date:
26 March 2018 (online)

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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
 

  • References

  • 1 Snell GI, Westall GP, Oto T. Donor risk prediction: how ‘extended’ is safe?. Curr Opin Organ Transplant 2013; 18 (05) 507-512
    CrossrefPubMedGoogle Scholar
  • 2 Cypel M, Levvey B, Van Raemdonck D. , et al. Lung transplantation using controlled donation after circulatory death donors: trials and tribulations. J Heart Lung Transplant 2016; 35 (01) 146-147
    CrossrefPubMedGoogle Scholar
  • 3 Chambers DC, Yusen RD, Cherikh WS. , et al; International Society for Heart and Lung Transplantation. The Registry of the International Society for Heart and Lung Transplantation: Thirty-fourth Adult Lung And Heart-Lung Transplantation Report-2017; Focus Theme: Allograft ischemic time. J Heart Lung Transplant 2017; 36 (10) 1047-1059
    CrossrefPubMedGoogle Scholar
  • 4 Australian and New Zealand Intensive Care Society. Death and organ donation. 2013. Available at: http://wwwanzicscomau/Pages/DaODaspx . Accessed September 1, 2017
    PubMedGoogle Scholar
  • 5 National Council of Commissioners of Uniform State Laws. Uniform Determination of Death Act. 1980. Available at: http://pntb.org/wordpress/wp-content/uploads/Uniform-Determination-of-Death-1980_5c.pdf
    PubMedGoogle Scholar
  • 6 Hassanain M, Simoneau E, Doi SA. , et al. Trends in brain-dead organ donor characteristics: a 13-year analysis. Can J Surg 2016; 59 (03) 154-160
    CrossrefPubMedGoogle Scholar
  • 7 Van Gelder F, Delbouille MH, Vandervennet M. , et al. An 11-year overview of the Belgian donor and transplant statistics based on a consecutive yearly data follow-up and comparing two periods: 1997 to 2005 versus 2006 to 2007. Transplant Proc 2009; 41 (02) 569-571
    CrossrefPubMedGoogle Scholar
  • 8 Wijdicks EF, Varelas PN, Gronseth GS, Greer DM. ; American Academy of Neurology. Evidence-based guideline update: determining brain death in adults: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2010; 74 (23) 1911-1918
    CrossrefPubMedGoogle Scholar
  • 9 Wahlster S, Wijdicks EF, Patel PV. , et al. Brain death declaration: practices and perceptions worldwide. Neurology 2015; 84 (18) 1870-1879
    CrossrefPubMedGoogle Scholar
  • 10 Clarke MJ, Fenton KN, Sade RM. Does declaration of brain death serve the best interest of organ donors rather than merely facilitating organ transplantation?. Ann Thorac Surg 2016; 101 (06) 2053-2058
    CrossrefPubMedGoogle Scholar
  • 11 Gostin LO. Legal and ethical responsibilities following brain death: the McMath and Muñoz cases. JAMA 2014; 311 (09) 903-904
    CrossrefPubMedGoogle Scholar
  • 12 Tonti-Filippini N. Religious and secular death: a parting of the ways. Bioethics 2012; 26 (08) 410-421
    CrossrefPubMedGoogle Scholar
  • 13 Oto T, Griffiths A, Levvey B. , et al. Donor history of asthma is not a contraindication to lung transplantation: 12-year single-center experience. J Heart Lung Transplant 2004; 23 (03) 309-316
    CrossrefPubMedGoogle Scholar
  • 14 Oto T, Griffiths AP, Levvey B. , et al. A donor history of smoking affects early but not late outcome in lung transplantation. Transplantation 2004; 78 (04) 599-606
    PubMedGoogle Scholar
  • 15 Paraskeva MA, Westall GP, Pilcher D. , et al. The Alfred Hospital lung transplant experience. Clin Transpl 2014; •••: 99-108
    PubMedGoogle Scholar
  • 16 Suhling H, Dettmer S, Rademacher J. , et al. Spirometric obstructive lung function pattern early after lung transplantation. Transplantation 2012; 93 (02) 230-235 [Corrected in “Transplantation. 2012;93(8):e37” (Note: Mark, Greer [corrected to Greer, Mark]).]
    CrossrefPubMedGoogle Scholar
  • 17 Fischer S, Gohrbandt B, Struckmeier P. , et al. Lung transplantation with lungs from donors fifty years of age and older. J Thorac Cardiovasc Surg 2005; 129 (04) 919-925
    CrossrefPubMedGoogle Scholar
  • 18 Sommer W, Ius F, Salman J. , et al. Survival and spirometry outcomes after lung transplantation from donors aged 70 years and older. J Heart Lung Transplant 2015; 34 (10) 1325-1333
    CrossrefPubMedGoogle Scholar
  • 19 Bozovic G, Steen S, Sjöberg T. , et al. Circulation stabilizing therapy and pulmonary high-resolution computed tomography in a porcine brain-dead model. Acta Anaesthesiol Scand 2016; 60 (01) 93-102
    CrossrefPubMedGoogle Scholar
  • 20 Hardy JD, Webb WR, Dalton Jr ML, Walker Jr GR. Lung homotransplantation in man. JAMA 1963; 186: 1065-1074
    PubMedGoogle Scholar
  • 21 Egan TM, Lambert Jr CJ, Reddick R, Ulicny Jr KS, Keagy BA, Wilcox BR. A strategy to increase the donor pool: use of cadaver lungs for transplantation. Ann Thorac Surg 1991; 52 (05) 1113-1120 , discussion 1120–1121
    CrossrefPubMedGoogle Scholar
  • 22 D'Alessandro AM, Hoffmann RM, Knechtle SJ. , et al. Controlled non-heart-beating donors: a potential source of extrarenal organs. Transplant Proc 1995; 27 (01) 707-709
    PubMedGoogle Scholar
  • 23 Steen S, Sjöberg T, Pierre L, Liao Q, Eriksson L, Algotsson L. Transplantation of lungs from a non-heart-beating donor. Lancet 2001; 357 (9259): 825-829
    CrossrefPubMedGoogle Scholar
  • 24 Levvey BJ, Harkess M, Hopkins P. , et al. Excellent clinical outcomes from a national donation-after-determination-of-cardiac-death lung transplant collaborative. Am J Transplant 2012; 12 (09) 2406-2413
    CrossrefPubMedGoogle Scholar
  • 25 Kootstra G, Daemen JH, Oomen AP. Categories of non-heart-beating donors. Transplant Proc 1995; 27 (05) 2893-2894
    PubMedGoogle Scholar
  • 26 Manara AR, Murphy PG, O'Callaghan G. Donation after circulatory death. Br J Anaesth 2012; 108 (Suppl. 01) i108-i121
    CrossrefPubMedGoogle Scholar
  • 27 Valenza F, Citerio G, Palleschi A. , et al. Successful transplantation of lungs from an uncontrolled donor after circulatory death preserved in situ by alveolar recruitment maneuvers and assessed by ex vivo lung perfusion. Am J Transplant 2016; 16 (04) 1312-1318
    CrossrefPubMedGoogle Scholar
  • 28 de Antonio DG, Marcos R, Laporta R. , et al. Results of clinical lung transplant from uncontrolled non-heart-beating donors. J Heart Lung Transplant 2007; 26 (05) 529-534
    CrossrefPubMedGoogle Scholar
  • 29 Dhital KK, Iyer A, Connellan M. , et al. Adult heart transplantation with distant procurement and ex-vivo preservation of donor hearts after circulatory death: a case series. Lancet 2015; 385 (9987): 2585-2591
    CrossrefPubMedGoogle Scholar
  • 30 Valapour M, Skeans MA, Heubner BM. , et al. OPTN/SRTR 2012 annual data report: lung. Am J Transplant 2014; 14 (Suppl. 01) 139-165
    CrossrefPubMedGoogle Scholar
  • 31 Eurotransplant International Foundation. Annual Report 2013. Available at: http://wwweurotransplantorg/cms/mediaobjectphp?file=AR20135pdf . Accessed 2016
    PubMedGoogle Scholar
  • 32 Durall AL, Laussen PC, Randolph AG. Potential for donation after cardiac death in a children's hospital. Pediatrics 2007; 119 (01) e219-e224
    CrossrefPubMedGoogle Scholar
  • 33 Bennett EE, Sweney J, Aguayo C, Myrick C, Antommaria AH, Bratton SL. Pediatric organ donation potential at a children's hospital. Pediatr Crit Care Med 2015; 16 (09) 814-820
    CrossrefPubMedGoogle Scholar
  • 34 Shore PM, Huang R, Roy L. , et al. Development of a bedside tool to predict time to death after withdrawal of life-sustaining therapies in infants and children. Pediatr Crit Care Med 2012; 13 (04) 415-422
    CrossrefPubMedGoogle Scholar
  • 35 Grasemann H, de Perrot M, Bendiak GN. , et al. ABO-incompatible lung transplantation in an infant. Am J Transplant 2012; 12 (03) 779-781
    CrossrefPubMedGoogle Scholar
  • 36 Pawale A, McKean M, Dark J, Hasan A. Successful pediatric single-lung transplantation with previous contralateral pneumonectomy, using controlled “donation after cardiac death” lung, for congenital pulmonary vein stenosis. J Thorac Cardiovasc Surg 2010; 139 (06) e125-e126
    CrossrefPubMedGoogle Scholar
  • 37 Lan C, Song JL, Yan LN. , et al. Pediatric donor to adult recipients in donation after cardiac death liver transplantation: a single-center experience. Transplant Proc 2017; 49 (06) 1383-1387
    CrossrefPubMedGoogle Scholar
  • 38 Marlais M, Pankhurst L, Hudson A, Sharif K, Marks SD. UK National Registry Study of kidney donation after circulatory death for pediatric recipients. Transplantation 2017; 101 (06) 1177-1181
    CrossrefPubMedGoogle Scholar
  • 39 Van Arendonk KJ, James NT, Locke JE, Montgomery RA, Colombani PM, Segev DL. Late graft loss among pediatric recipients of DCD kidneys. Clin J Am Soc Nephrol 2011; 6 (11) 2705-2711
    CrossrefPubMedGoogle Scholar
  • 40 Casswell GK, Pilcher DV, Martin RS. , et al. Buying time: the use of extracorporeal membrane oxygenation as a bridge to lung transplantation in pediatric patients. Pediatr Transplant 2013; 17 (08) E182-E188
    CrossrefPubMedGoogle Scholar
  • 41 Marasco SF, Than S, Keating D. , et al. Cadaveric lobar lung transplantation: technical aspects. Ann Thorac Surg 2012; 93 (06) 1836-1842
    CrossrefPubMedGoogle Scholar
  • 42 Snell G, Levvey BJ, Paraskeva M. , et al. Controlled DCD donors and pediatric lung transplant: enhanced opportunities and excellent outcomes. J Heart Lung Transplant 2016; 35 (4S): S34-S35
    PubMedGoogle Scholar
  • 43 Sundaresan S, Trachiotis GD, Aoe M, Patterson GA, Cooper JD. Donor lung procurement: assessment and operative technique. Ann Thorac Surg 1993; 56 (06) 1409-1413
    CrossrefPubMedGoogle Scholar
  • 44 Orens JB, Boehler A, de Perrot M. , et al; Pulmonary Council, International Society for Heart and Lung Transplantation. A review of lung transplant donor acceptability criteria. J Heart Lung Transplant 2003; 22 (11) 1183-1200
    CrossrefPubMedGoogle Scholar
  • 45 Reyes KG, Mason DP, Thuita L. , et al. Guidelines for donor lung selection: time for revision?. Ann Thorac Surg 2010; 89 (06) 1756-1764 , discussion 1764–1765
    CrossrefPubMedGoogle Scholar
  • 46 Kotloff RM, Blosser S, Fulda GJ. , et al; Society of Critical Care Medicine/American College of Chest Physicians/Association of Organ Procurement Organizations Donor Management Task Force. Management of the potential organ donor in the ICU: Society of Critical Care Medicine/American College of Chest Physicians/Association of Organ Procurement Organizations Consensus Statement. Crit Care Med 2015; 43 (06) 1291-1325
    CrossrefPubMedGoogle Scholar
  • 47 Zych B, García Sáez D, Sabashnikov A. , et al. Lung transplantation from donors outside standard acceptability criteria–are they really marginal?. Transpl Int 2014; 27 (11) 1183-1191
    CrossrefPubMedGoogle Scholar
  • 48 Snell GI, Griffiths A, Levvey BJ, Oto T. Availability of lungs for transplantation: exploring the real potential of the donor pool. J Heart Lung Transplant 2008; 27 (06) 662-667
    CrossrefPubMedGoogle Scholar
  • 49 Snell GI, Westall GP. Selection and management of the lung donor. Clin Chest Med 2011; 32 (02) 223-232
    CrossrefPubMedGoogle Scholar
  • 50 Bansal R, Esan A, Hess D. , et al. Mechanical ventilatory support in potential lung donor patients. Chest 2014; 146 (01) 220-227
    CrossrefPubMedGoogle Scholar
  • 51 Andreasson AS, Dark JH, Fisher AJ. Ex vivo lung perfusion in clinical lung transplantation–state of the art. Eur J Cardiothorac Surg 2014; 46 (05) 779-788
    CrossrefPubMedGoogle Scholar
  • 52 Alberg AJ, Ford JG, Samet JM. ; American College of Chest Physicians. Epidemiology of lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition). Chest 2007; 132 (3 Suppl): 29S-55S
    CrossrefPubMedGoogle Scholar
  • 53 Diamond JM, Lee JC, Kawut SM. , et al; Lung Transplant Outcomes Group. Clinical risk factors for primary graft dysfunction after lung transplantation. Am J Respir Crit Care Med 2013; 187 (05) 527-534
    CrossrefPubMedGoogle Scholar
  • 54 Sabashnikov A, Patil NP, Mohite PN. , et al. Influence of donor smoking on midterm outcomes after lung transplantation. Ann Thorac Surg 2014; 97 (03) 1015-1021
    CrossrefPubMedGoogle Scholar
  • 55 Australian and New Zealand Dialysis and Transplant Registry, 2016 Annual Report. Available at: http://www.anzdata.org.au/anzod/v1/indexanzod.html . Accessed September 2, 2017
    PubMed
  • 56 Novick RJ, Bennett LE, Meyer DM, Hosenpud JD. Influence of graft ischemic time and donor age on survival after lung transplantation. J Heart Lung Transplant 1999; 18 (05) 425-431
    CrossrefPubMedGoogle Scholar
  • 57 De Perrot M, Waddell TK, Shargall Y. , et al. Impact of donors aged 60 years or more on outcome after lung transplantation: results of an 11-year single-center experience. J Thorac Cardiovasc Surg 2007; 133 (02) 525-531
    CrossrefPubMedGoogle Scholar
  • 58 López I, Zapata R, Solé J. , et al. Early and mid-term results of lung transplantation with donors 60 years and older. Interact Cardiovasc Thorac Surg 2015; 20 (01) 47-53
    CrossrefPubMedGoogle Scholar
  • 59 Hayes Jr D, Black SM, Tobias JD, Higgins RS, Whitson BA. Influence of donor and recipient age in lung transplantation. J Heart Lung Transplant 2015; 34 (01) 43-49
    CrossrefPubMedGoogle Scholar
  • 60 Dholakia S, Johns R, Muirhead L, Papalois V, Crane J. Renal donors with prostate cancer, no longer a reason to decline. Transplant Rev (Orlando) 2016; 30 (01) 48-50
    CrossrefPubMedGoogle Scholar
  • 61 Loh E, Couch FJ, Hendricksen C. , et al. Development of donor-derived prostate cancer in a recipient following orthotopic heart transplantation. JAMA 1997; 277 (02) 133-137
    CrossrefPubMedGoogle Scholar
  • 62 Avlonitis VS, Fisher AJ, Kirby JA, Dark JH. Pulmonary transplantation: the role of brain death in donor lung injury. Transplantation 2003; 75 (12) 1928-1933
    CrossrefPubMedGoogle Scholar
  • 63 Kang CH, Anraku M, Cypel M. , et al. Transcriptional signatures in donor lungs from donation after cardiac death vs after brain death: a functional pathway analysis. J Heart Lung Transplant 2011; 30 (03) 289-298
    CrossrefPubMedGoogle Scholar
  • 64 Saxena P, Zimmet AD, Snell G, Levvey B, Marasco SF, McGiffin DC. Procurement of lungs for transplantation following donation after circulatory death: the Alfred technique. J Surg Res 2014; 192 (02) 642-646
    CrossrefPubMedGoogle Scholar
  • 65 Yeung JC, Cypel M, Keshavjee S. Ex-vivo lung perfusion: the model for the organ reconditioning hub. Curr Opin Organ Transplant 2017; 22 (03) 287-289
    CrossrefPubMedGoogle Scholar
  • 66 Snell GI, Levvey BJ, Westall GP. The changing landscape of lung donation for transplantation. Am J Transplant 2015; 15 (04) 859-860
    CrossrefPubMedGoogle Scholar
  • 67 Hidalgo MA, Shah KA, Fuller BJ, Green CJ. Cold ischemia-induced damage to vascular endothelium results in permeability alterations in transplanted lungs. J Thorac Cardiovasc Surg 1996; 112 (04) 1027-1035
    CrossrefPubMedGoogle Scholar
  • 68 Cypel M, Keshavjee S. Extending the donor pool: rehabilitation of poor organs. Thorac Surg Clin 2015; 25 (01) 27-33
    CrossrefPubMedGoogle Scholar
  • 69 Yeung JC, Cypel M, Machuca TN. , et al. Physiologic assessment of the ex vivo donor lung for transplantation. J Heart Lung Transplant 2012; 31 (10) 1120-1126
    CrossrefPubMedGoogle Scholar
  • 70 Fischer S, Liu M, MacLean AA. , et al. In vivo transtracheal adenovirus-mediated transfer of human interleukin-10 gene to donor lungs ameliorates ischemia-reperfusion injury and improves early posttransplant graft function in the rat. Hum Gene Ther 2001; 12 (12) 1513-1526
    CrossrefPubMedGoogle Scholar
  • 71 Machuca TN, Mercier O, Collaud S. , et al. Lung transplantation with donation after circulatory determination of death donors and the impact of ex vivo lung perfusion. Am J Transplant 2015; 15 (04) 993-1002
    CrossrefPubMedGoogle Scholar
  • 72 Wallinder A, Ricksten SE, Hansson C. , et al. Transplantation of initially rejected donor lungs after ex vivo lung perfusion. J Thorac Cardiovasc Surg 2012; 144 (05) 1222-1228
    CrossrefPubMedGoogle Scholar
  • 73 Nakajima D, Cypel M, Bonato R. , et al. Ex vivo perfusion treatment of infection in human donor lungs. Am J Transplant 2016; 16 (04) 1229-1237
    CrossrefPubMedGoogle Scholar
  • 74 Opdam HI, Silvester W. Potential for organ donation in Victoria: an audit of hospital deaths. Med J Aust 2006; 185 (05) 250-254
    PubMedGoogle Scholar
  • 75 Opdam H. Intensive care solely to facilitate organ donation-new challenges. Transplantation 2017; 101 (08) 1746-1747
    CrossrefPubMedGoogle Scholar
  • 76 Coulson TG, Pilcher DV, Graham SM. , et al. Single-centre experience of donation after cardiac death. Med J Aust 2012; 197 (03) 166-169
    CrossrefPubMedGoogle Scholar
  • 77 Sidiropoulos S, Treasure E, Silvester W, Opdam H, Warrillow SJ, Jones D. Organ donation after circulatory death in a university teaching hospital. Anaesth Intensive Care 2016; 44 (04) 477-483
    PubMedGoogle Scholar
  • 78 Sampson BG, O'Callaghan GP, Russ GR. Is donation after cardiac death reducing the brain-dead donor pool in Australia?. Crit Care Resusc 2013; 15 (01) 21-27
    PubMedGoogle Scholar
  • 79 Rakhra SS, Opdam HI, Gladkis L. , et al. Untapped potential in Australian hospitals for organ donation after circulatory death. Med J Aust 2017; 207 (07) 294-301
    CrossrefPubMedGoogle Scholar
  • 80 Cypel M, Levvey B, Van Raemdonck D. , et al; International Society for Heart and Lung Transplantation. International Society for Heart and Lung Transplantation donation after circulatory death registry report. J Heart Lung Transplant 2015; 34 (10) 1278-1282
    CrossrefPubMedGoogle Scholar
  • 81 Levvey BJ, Whitford HM, Williams TJ. , et al. Donation after circulatory determination of death lung transplantation for pulmonary arterial hypertension: passing the toughest test. Am J Transplant 2015; 15 (12) 3208-3214
    CrossrefPubMedGoogle Scholar
  • 82 Brieva J, Opdam H, Jones D. Predicting the time to death after withdrawal of life sustaining therapy: implications for organ donation. Crit Care Med 2012; 40 (01) 342-344
    CrossrefPubMedGoogle Scholar
  • 83 Reeb J, Keshavjee S, Cypel M. 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 (02) 258-259
    CrossrefPubMedGoogle Scholar
  • 84 Detry O, Le Dinh H, Noterdaeme T. , et al. Categories of donation after cardiocirculatory death. Transplant Proc 2012; 44 (05) 1189-1195
    CrossrefPubMedGoogle Scholar
  • 85 Snell GIWG, Paraskeva M, Westall GP. Donor selection and management. Semin Respir Crit Care Med 2013; 34 (03) 361-370
    Article in Thieme ConnectPubMedGoogle Scholar
  • 86 Gomez-de-Antonio D, Campo-Cañaveral JL, Crowley S. , et al. Clinical lung transplantation from uncontrolled non-heart-beating donors revisited. J Heart Lung Transplant 2012; 31 (04) 349-353
    CrossrefPubMedGoogle Scholar
  • 87 Egan TM. Lung transplant from an uncontrolled donation after circulatory determination of death donor: moving to other countries. Am J Transplant 2016; 16 (04) 1051-1052
    CrossrefPubMedGoogle Scholar
  • 88 Oto T, Levvey BJ, Whitford H. , et al. Feasibility and utility of a lung donor score: correlation with early post-transplant outcomes. Ann Thorac Surg 2007; 83 (01) 257-263
    CrossrefPubMedGoogle Scholar
  • 89 Loor G, Radosevich DM, Kelly RF. , et al. The University of Minnesota Donor Lung Quality Index: a consensus-based scoring application improves donor lung use. Ann Thorac Surg 2016; 102 (04) 1156-1165
    CrossrefPubMedGoogle Scholar
  • 90 Huppmann P, Neurohr C, Leuschner S. , et al; Munich Lung Transplant Group (MLTG). The Munich-LTX-Score: predictor for survival after lung transplantation. Clin Transplant 2012; 26 (01) 173-183
    CrossrefPubMedGoogle Scholar
  • 91 Levin K, Kotecha S, Westall G, Snell G. How can we improve the quality of transplantable lungs?. Expert Rev Respir Med 2016; 10: 1-7
    CrossrefPubMedGoogle Scholar
  • 92 Cypel M, Keshavjee S. Extracorporeal lung perfusion (ex-vivo lung perfusion). Curr Opin Organ Transplant 2016; 21 (03) 329-335
    CrossrefPubMedGoogle Scholar
  • 93 Shaver CM, Ware LB. Primary graft dysfunction: pathophysiology to guide new preventive therapies. Expert Rev Respir Med 2017; 11 (02) 119-128
    CrossrefPubMedGoogle Scholar
  • 94 Snell GI, Yusen RD, Weill D. , et al. Report of the ISHLT Working Group on PGD: Part 1, Definition and Grading; a 2017 Consensus Group Statement. J Heart Lung Transplant 2017; 36: 1097-1103
    CrossrefPubMedGoogle Scholar
  • 95 Machuca TN, Cypel M, Bonato R. , et al. Safety and efficacy of ex vivo donor lung adenoviral IL-10 gene therapy in a large animal lung transplant survival model. Hum Gene Ther 2017; 28 (09) 757-765
    CrossrefPubMedGoogle Scholar
  • 96 Otani S, Oto T, Kakishita T. , et al. Early effects of the ex vivo evaluation system on graft function after swine lung transplantation. Eur J Cardiothorac Surg 2011; 40 (04) 956-961
    PubMedGoogle Scholar
  • 97 Bhorade SM, Vigneswaran W, McCabe MA, Garrity ER. Liberalization of donor criteria may expand the donor pool without adverse consequence in lung transplantation. J Heart Lung Transplant 2000; 19 (12) 1199-1204
    CrossrefPubMedGoogle Scholar
  • 98 Angel LF, Levine DJ, Restrepo MI. , et al. Impact of a lung transplantation donor-management protocol on lung donation and recipient outcomes. Am J Respir Crit Care Med 2006; 174 (06) 710-716
    CrossrefPubMedGoogle Scholar