Cadaveric Donor Selection and Management

ABSTRACT

While there is little doubt that proper donor selection is extremely important to achieve good outcomes from transplantation, there are only limited data regarding the current criteria utilized to select the “ideal donor”. Importantly, there are not enough donor lungs available for all of those in need. Until an adequate supply of donor organs exists, lives will be lost on the transplant waiting list. While efforts have been made to increase donor awareness, additional transplants can be realized by improving donor utilization. This can be achieved by active participation of transplant teams in donor management and by utilizing “extended criteria” organs. Further studies are needed to assess the impact of using “extended criteria” donors, as this practice could result in increased posttransplant morbidity and mortality. This article summarizes the approach to identification of potential lung donors, optimal donor management, and the clinical importance of various donor factors upon recipient outcomes.

KEYWORDS

Lung transplant - extended criteria - organ donation - organ procurement

REFERENCES

• 1 UNOS data. 2003 http://www.UNOS.org
• 2 Egan T M, Murray S, Bustami R T et al.. Development of the new lung allocation system in the United States.  Am J Transplant. 2006;  6(5 Pt 2) 1212-1227
• 3 Bowdish M E, Barr M L. Living lobar lung transplantation.  Respir Care Clin N Am. 2004;  10 563-579
• 4 Steen S, Liao Q, Wierup P N, Bolys R, Pierre L, Sjoberg T. Transplantation of lungs from non-heart-beating donors after functional assessment ex vivo.  Ann Thorac Surg. 2003;  76 244-252
• 5 Olson L, Cravero L, Kisthard J, Ward S, Marks W. Donation after cardiac death has a minimal impact on thoracic organ recovery.  Prog Transplant. 2006;  16 141-143
• 6 D'Alessandro A M, Fernandez L A, Chin L T et al.. Donation after cardiac death: the University of Wisconsin experience.  Ann Transplant. 2004;  9 68-71
• 7 Cooper D K, Keogh A M, Brink J et al.. Report of the Xenotransplantation Advisory Committee of the International Society for Heart and Lung Transplantation: the present status of xenotransplantation and its potential role in the treatment of end-stage cardiac and pulmonary diseases.  J Heart Lung Transplant. 2000;  19 1125-1165
• 8 Bart K J, Macon E J, Humphries Jr A L et al.. Increasing the supply of cadaveric kidneys for transplantation.  Transplantation. 1981;  31 383-387
• 9 Evans R W. The actual and potential supply of organ donors in the United States.  Clin Transpl. 1990;  329-341
• 10 Mackersie R C, Bronsther O L, Shackford S R. Organ procurement in patients with fatal head injuries: the fate of the potential donor.  Ann Surg. 1991;  213 143-150
• 11 A definition of irreversible coma. Report of the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death.  JAMA. 1968;  205 337-340
• 12 Rosendale J D, Kauffman H M, McBride M A et al.. Aggressive pharmacologic donor management results in more transplanted organs.  Transplantation. 2003;  75 482-487
• 13 Rosendale J D, Kauffman H M, McBride M A et al.. Hormonal resuscitation yields more transplanted hearts with improved early function.  Transplantation. 2003;  75 1336-1341
• 14 Angel L F, Levine D J, Restrepo M I et al.. Impact of a lung transplantation donor-management protocol on lung donation and recipient outcomes.  Am J Respir Crit Care Med. 2006;  174 710-716
• 15 Straznicka M, Follette D M, Eisner M D, Roberts P F, Menza R L, Babcock W D. Aggressive management of lung donors classified as unacceptable: excellent recipient survival one year after transplantation.  J Thorac Cardiovasc Surg. 2002;  124 250-258
• 16 Kawut S M, Reyentovich A, Wilt J S et al.. Outcomes of extended donor lung recipients after lung transplantation.  Transplantation. 2005;  79 310-316
• 17 Aigner C, Winkler G, Jaksch P et al.. Extended donor criteria for lung transplantation: a clinical reality.  Eur J Cardiothorac Surg. 2005;  27 757-761
• 18 Lardinois D, Banysch M, Korom S et al.. Extended donor lungs: eleven years experience in a consecutive series.  Eur J Cardiothorac Surg. 2005;  27 762-767
• 19 Orens J B, Boehler A, de Perrot M et al.. A review of lung transplant donor acceptability criteria.  J Heart Lung Transplant. 2003;  22 1183-1200
• 20 Miyoshi S, Trulock E P, Shaefers H, Hsie C, Patterson G A, Cooper J D. Cardiopulmonary exercise testing after single and double lung transplantation.  Chest. 1990;  97 1130-1136
• 21 United Network for Organ Sharing . Guidelines for multiorgan donor management and procurement.  UNOS Update. 1993;  14-15
• 22 Novick R J, Bennett L E, Meyer D M, Hosenpud J D. Influence of graft ischemic time and donor age on survival after lung transplantation.  J Heart Lung Transplant. 1999;  18 425-431
• 23 Meyer D M, Bennett L E, Novick R J, Hosenpud J D. Effect of donor age and ischemic time in intermediate survival and morbidity after lung transplantation.  Chest. 2000;  118 1255-1262
• 24 Hosenpud J D, Bennett L E, Keck B M, Boucek M M, Novick R J. The registry of the International Society for Heart and Lung Transplantation: eighteenth official report-2001.  J Heart Lung Transplant. 2001;  20 805-815
• 25 Bhorade S M, Vigneswaran W, McCabe M A, Garrity E R. Liberalization of donor criteria may expand the donor pool without adverse consequence in lung transplantation.  J Heart Lung Transplant. 2000;  19 1199-1204
• 26 Sundaresan S, Semenkovich J, Ochoa L et al.. Successful outcome of lung transplantation is not compromised by the use of marginal donor lungs.  J Thorac Cardiovasc Surg. 1995;  109 1075-1079
• 27 Sommers K E, Griffith B P, Hardesty R L, Keenan R J. Early lung allograft function in twin recipients from the same donor: risk factor analysis.  Ann Thorac Surg. 1996;  62 784-790
• 28 Hosenpud J D, Bennett L E, Keck B M, Fiol B, Novick R J. The registry of the International Society for Heart and Lung Transplantation: Fourteenth official report-1997.  J Heart Lung Transplant. 1997;  16 691-694
• 29 Snell G I, Rabinov M, Griffits A et al.. Pulmonary allograft ischemic time: an important predictor of survival after lung transplantation.  J Heart Lung Transplant. 1996;  15 169-174
• 30 Gammie J S, Dtukus D R, Pham S M et al.. Effect of ischemic time on survival in clinical lung transplantation.  Ann Thorac Surg. 1999;  68 2015-2020
• 31 Pierson III R N, Loyd J E, Goodwin A et al.. Successful management of an ABO-mismatched lung allograft using antigen-specific immunoadsorption, complement inhibition, and immunomodulatory therapy.  Transplantation. 2002;  74 79-84
• 32 Warren D S, Zachary A A, Sonnenday C J et al.. Successful renal transplantation across simultaneous ABO incompatible and positive crossmatch barriers.  Am J Transplant. 2004;  4 561-568
• 33 Starzl T E, Tzakis A, Makowka L et al.. The definition of ABO factors in transplantation: relation to other humoral antibody states.  Transplant Proc. 1987;  19 4492-4497
• 34 Yu N C, Haug III M T, Khan S U et al.. Does the donor-recipient ABO blood group compatibility status predict subsequent lung transplantation outcomes?.  J Heart Lung Transplant. 1999;  18 764-768
• 35 Novick R J, Schafers H J, Stitt L et al.. Recurrence of obliterative bronchiolitis and determinants of outcome in 139 pulmonary retransplant recipients.  J Thorac Cardiovasc Surg. 1995;  110 1402-1413
• 36 Sato M, Gutierrez C, Kaneda H, Liu M, Waddell T K, Keshavjee S. The effect of gender combinations on outcome in human lung transplantation: the International Society of Heart and Lung Transplantation Registry experience.  J Heart Lung Transplant. 2006;  25 634-637
• 37 Lillehei C W, Shamberger R C, Mayer J E et al.. Size disparity in pediatric lung transplantation.  J Pediatr Surg. 1994;  29 1152-1155
• 38 Loring S H, Leith D E, Connolly M J, Ingenito E P, Mentzer S J, Reilly J J. Model of functional restriction in chronic obstructive pulmonary disease, transplantation, and lung reduction surgery.  Am J Respir Crit Care Med. 1999;  160 821-828
• 39 Otulana B A, Mist B A, Scott J P, Wallwork J, Higenbottam T. The effect of recipient lung size on lung physiology after heart-lung transplantation.  Transplantation. 1989;  48 625-629
• 40 Tamm M, Higenbottam T, Dennis C M, Sharples L D, Wallwork J. Donor and recipient predicted lung volume and lung size after heart-lung transplantation.  Am J Respir Crit Care Med. 1994;  150 403-407
• 41 Lloyd K S, Barnard P, Holland V A, Noon G P, Lawrence E C. Pulmonary function after heart-lung transplantation using larger donor organs.  Am Rev Respir Dis. 1990;  142 1026-1029
• 42 Wisser W, Klepetko W, Wekerle T et al.. Tailoring of the lung to overcome size disparities in lung transplantation.  J Heart Lung Transplant. 1996;  15 239-242
• 43 Egan T, Thompson J T, Detterbeck F C et al.. Effect of size (mis) matching in clinical double-lung transplantation.  Transplantation. 1995;  59 707-713
• 44 Ciccone A M, Stewart K C, Meyers B F et al.. Does donor cause of death affect the outcome of lung transplantation?.  J Thorac Cardiovasc Surg. 2002;  123 429-434
• 45 The US .Organ Procurement and Transplantation Network and the Scientific Registry of Transplant Recipients. The Organ Procurement and Transplant Network/ SRTR Annual Report. 2005
• 46 Torres A, el-Ebiary M, Rano A. Respiratory infectious complications in the intensive care unit.  Clin Chest Med. 1999;  20 287-301
• 47 Ciulli F, Tamm M, Dennis C M et al.. Donor-transmitted bacterial infection in heart-lung transplantation.  Transplant Proc. 1993;  25 1155-1156
• 48 Puskas J D, Winton T L, Miller J D, Scavuzzo M, Patterson G A. Unilateral donor lung dysfunction does not preclude successful contralateral single-lung transplantation.  J Thorac Cardiovasc Surg. 1992;  103 1015-1017
• 49 Pierre A F, Sekine Y, Hutcheon M, Waddell T K, Keshavjee S. Marginal lung donors: a reassessment.  J Thorac Cardiovasc Surg. 2002;  123 421-428
• 50 Harjula A, Baldwin J C, Starnes V A et al.. Proper donor selection for heart-lung transplantation. The Stanford experience.  J Thorac Cardiovasc Surg. 1987;  94 874-880
• 51 Griffith B P, Zenati M. The pulmonary donor.  Clin Chest Med. 1990;  11 217-226
• 52 Stewart S, Ciulli F, Wells F C et al.. Pathology of unused donor lungs.  Transplant Proc. 1993;  25 1167-1168
• 53 Weill D, Dey G C, Young K R et al.. A positive donor Gram stain does not predict the development of pneumonia, oxygenation or duration of mechanical ventilation following lung transplantation [abstract].  J Heart Lung Transplant. 2001;  20 255
• 54 Gabbay E, Williams T J, Griffiths A P et al.. Maximizing the utilization of donor organs offered for lung transplantation.  Am J Respir Crit Care Med. 1999;  160 265-271
• 55 Zenati M, Dowling R D, Dummer J S et al.. Influence of the donor lung on development of early infections in lung transplant recipients.  J Heart Lung Transplant. 1990;  9 502-509
• 56 Dowling R D, Zenati M, Yousem S A et al.. Donor-transmitted pneumonia in experimental lung allografts: successful prevention with donor antibiotic therapy.  J Thorac Cardiovasc Surg. 1992;  103 767-772
• 57 Bonde P N, Patel N D, Borja M C et al.. Impact of donor lung organisms on post-lung transplant pneumonia.  J Heart Lung Transplant. 2006;  25 99-105
• 58 Avlonitis V S, Krause A, Luzzi L et al.. Bacterial colonization of the donor lower airways is a predictor of poor outcome in lung transplantation.  Eur J Cardiothorac Surg. 2003;  24 601-607
• 59 Follette D M, Rudich S M, Babcock W D. Improved oxygenation and increased lung donor recovery with high-dose steroid administration after brain death.  J Heart Lung Transplant. 1998;  17 423-429
• 60 Conte Jr J V, Ferber L R, Borja M et al.. Lung transplantation from dialysis dependent donors.  J Heart Lung Transplant. 2000;  19 894-896
• 61 Shumway S J, Hertz M I, Petty M G, Bolman R M. Liberalization of donor criteria in lung and heart-lung transplantation.  Ann Thorac Surg. 1994;  57 92-95
• 62 Penn I. Donor transmitted disease: cancer.  Transplant Proc. 1991;  23 2629-2631