Donor selection and management

The scarcity of suitable donor organs continues to limit lung transplantation, resulting in long waiting times and significant mortality for those patients listed for transplant. Strategies to expand the donor pool can substantially lift donor lung utilization rates from historically low levels of less than 20% to rates greater than 50%. This article reviews recent developments in the selection, assessment and management of the potential lung donor that aim to increase donor organ use.

Close adherence to the originally published lung transplant donor acceptability criteria has historically restricted the number of donor lungs available for transplant. Important advances that aim to increase donor lung utilization include the use of donation after cardiac death lungs, cut-down lungs and expanded criteria lungs. Emerging diagnostic tools that predict how donor lungs will function after transplant are likely to facilitate selection of appropriate donor lungs significantly in the future.

Optimal donor management should aim to maximize lung donation through aggressive donor management and consideration of the complete and expanded donor pool. However, long-term studies are required to validate such an approach and to confirm that long-term outcomes are not being compromised by the use of both traditional and nontraditional organ donors.