Objective: There is a shortage of organs available for transplantation, yet only 25% of lungs from donors after neurologic determination of death (DNDDs) are currently utilized. The current models to predict donor lung utilization lack donor critical care management data. Therefore, we sought to identify novel modifiable predictors in the donor that are associated with increased lung utilization in efforts to optimize donor management and increase the number of transplantable lungs.

Methods: A prospective, observational study of 13 organ procurement organizations in the United Network for Organ Sharing (UNOS) regions 1, 3, 4, 5, 6 and 10 from March 2012-November 2016 was conducted utilizing the UNOS donor management goals (DMGs) registry web portal. The DMG Bundle consists of nine standardized critical care endpoints that reflect the normal hemodynamic, respiratory, acid-base, renal, and endocrine status of the donor. The Bundle is considered “met” when 7 of the 9 elements are achieved. Donor demographic, critical care, and treatment data were collected at 3 time points during the donor management process: authorization for donation, initial organ allocation, and prior to organ recovery. The primary outcome measure was donor lung utilization defined as at least one lung transplanted from a given donor. Multivariable logistic regression was used to identify independent predictors with a p <0.05.

Results: Of 5592 DNDDs, 1445 (26%) lungs were transplanted. After multivariable analysis, independent positive donor predictors of lung utilization included Standard Criteria Donor status (OR 1.50), blood type O (OR 1.23), cause of death due to head trauma (OR 1.79) or stroke (OR 2.02), BMI < 30 kg/m2 (OR 1.43), vasopressin use (OR 1.29), steroid use (OR 1.48), CVP 4-12 mm Hg (OR 1.34), Ejection Fraction > 50% (OR 1.34), PaO2/FiO2 > 300 (OR 4.36), and the DMG Bundle Met at authorization (OR 1.35), allocation (OR 1.57), and prior to organ recovery (OR 2.28). Independent negative predictors included donor age (OR 0.97 per year), neosynephrine use (OR 0.74), norepinephrine use (OR 0.77), and epinephrine use (0.50).

Conclusion: Donor demographic and, more importantly, modifiable critical care parameters predict lung utilization. Further investigation of the impact of donor critical care parameters on lung recipient survival is warranted in order to optimize donor management and inform organ acceptance practices.

CITATION INFORMATION: Spaugy A, Sally M, Ellis K, Groat T, Patel M, Malinoski D. Modifiable Deceased Organ Donor Critical Care Parameters Impact Donor Lung Utilization. Am J Transplant. 2017;17 (suppl 3).

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