Background: Lung utilization rates for deceased donor (DD) are far lower than most solid organs. For DD recovered in 2013, 22% had at least one lung transplanted, compared to 78% for kidney, 74% for liver, 31% for heart, and 13% for pancreas. This analysis was performed to identify DD characteristics associated with a higher rate of lungs being transplanted.

Data and Methods: The cohort included all DD reported to the OPTN, and from whom at least one organ was recovered between 2009 and 2013 with the intent to transplant. Lung donation groupings (LDGs) were developed based on a classification tree analysis for lung utilization, defined as at least one lung transplanted. Donor characteristics considered for the LDGs were reported by OPOs on the Deceased Donor Registration form.

Results: There were 40,502 DD between 2009 and 2013; 8349 (20.6%) had at least one lung transplanted. Six distinct LDGs were identified and analyzed, based on 5 donor characteristics: donor age; DCD; history of cigarette use; PaO_2; and PaO₂/FiO₂ ratio. The LDGs had lung utilization rates ranging from 1.9% to 72.8%. The applicability of the LDGs was validated for a more recent 8-month cohort of donors, with a c-statistic of 0.89 in a logistic regression analysis.

Lung utilization rates by LDG

Conclusions: The lung utilization rate in the analysis cohort was 20.6%. Based on only five donor factors, distinct lung utilization groups were identified with rates having an almost 40-fold range (1.9% to 72.8%). Over 20% of the donors were in LDGs with lung utilization rates of 50% or higher. Of the five factors used to determine the LDGs, only two are modifiable through donor management: PaO₂ and PaO₂/FiO₂ ratio.

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