Risk Aversion in Lung Transplantation: Organ Procurement Organizations Differ in Willingness to Pursue Non-Ideal Donor Organs

S. E. Halpern¹, A. McConnell², S. Peskoe², V. Raman³, O. K. Jawitz³, A. Y. Choi¹, J. C. Haney³, J. A. Klapper³, M. G. Hartwig³

¹Duke University School of Medicine, Durham, NC, ²Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, ³Department of Surgery, Duke University Medical Center, Durham, NC

Meeting: 2020 American Transplant Congress

Abstract number: 395

Keywords: Donors, marginal, Lung transplantation

Session Information

Session Name: Lung: Let's Start at the Beginning: Pre-Transplant Decision Making and Access to Lung Donors

Session Type: Oral Abstract Session

Date: Saturday, May 30, 2020

Session Time: 3:15pm-4:45pm

Presentation Time: 4:15pm-4:27pm

Location: Virtual

*Purpose: Lungs from non-ideal deceased donors are disproportionally discarded despite evidence that waitlisted candidates benefit from use of these organs. Organ procurement organizations (OPOs) individually define “acceptable” deceased donor organs, however existing OPO performance metrics do not capture the resulting variability in donor pursuit. We characterized patterns of non-ideal donor pursuit among OPOs to identify factors associated with risk aversion in lung transplantation (LTx).

*Methods: We queried the UNOS registry for adult donors who donated at least one organ for transplantation between 12/2007-12/2018. Non-ideal donors were those with any of the following characteristics: age>50, smoking history ≥20 pack-years, PaO₂/FiO₂ (P/F) ratio<350, donation after cardiac death (DCD) status, or CDC increased risk (IRD) status. The rate of non-ideal donor pursuit was defined as the proportion of non-ideal donors at each OPO from whom consent for lung donation was requested with lower numbers corresponding to increased risk aversion. We estimated the correlation between non-ideal and overall donor pursuit using a Spearman correlation coefficient. Adjusted rates of non-ideal donor pursuit were estimated using multivariable logistic regression.

*Results: Overall, 18,333 deceased donors were included and classified as ideal or non-ideal. Among 58 OPOs, rates of non-ideal donor pursuit ranged from 0.24-1.00 (Figure). Of 5 non-ideal characteristics, DCD and IRD status were associated with the most and least risk aversion, respectively. Non-ideal donor pursuit was strongly correlated with overall donor pursuit (r=0.99). On adjusted analysis, older age (OR 0.15, 95% CI 0.13-0.16), smoking history (OR 0.38, 95% CI 0.34-0.44), low P/F ratio (OR 0.12, 95% CI 0.11-0.14), and DCD status (OR 0.04, 95% CI 0.03-0.04) were all independently associated with significant risk aversion, corresponding to decreased rates of donor pursuit.

*Conclusions: OPOs differ in their levels of risk aversion in LTx and risk aversion is not uniform across selected categories of non-ideal lung donor. Consideration of new OPO performance metrics that encourage the pursuit of non-ideal lung donors is warranted.

To cite this abstract in AMA style:

Halpern SE, McConnell A, Peskoe S, Raman V, Jawitz OK, Choi AY, Haney JC, Klapper JA, Hartwig MG. Risk Aversion in Lung Transplantation: Organ Procurement Organizations Differ in Willingness to Pursue Non-Ideal Donor Organs [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/risk-aversion-in-lung-transplantation-organ-procurement-organizations-differ-in-willingness-to-pursue-non-ideal-donor-organs/. Accessed May 12, 2025.

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