Initial experience with lung donation after cardiocirculatory death in Canada

Area of Science:

• Transplantation immunology
• Thoracic surgery
• Organ donation research

Background:

• Organ donation after cardiac death (DCD) offers a potential solution to the critical shortage of donor lungs for transplantation.
• Limited data currently exist on the outcomes of DCD lung transplantation.
• This study aims to describe the early and intermediate outcomes of DCD lung transplantation in Canada.

Purpose of the Study:

• To evaluate the clinical outcomes of lung transplantation using organs from donors after cardiac death (DCD).
• To assess the utilization rates and post-transplant complications associated with DCD lung transplants.
• To report on patient survival and graft function following DCD lung transplantation.

Main Methods:

• Retrospective data collection from DCD lung transplant donors and recipients between June 2006 and December 2008.
• Analysis of the DCD lung protocol, donor characteristics, and post-transplant events including primary graft dysfunction (PGD), bronchial complications, acute rejection (AR), and bronchiolitis obliterans syndrome (BOS).
• Evaluation of patient survival, intensive care unit (ICU) stay, and hospital length of stay.

Main Results:

• The number of controlled DCD donors increased significantly from 2006 to 2008, with lung utilization rates rising to 27% in 2008.
• Nine DCD donors provided lungs for 10 recipients, with 0% 30-day mortality and only one case of severe PGD requiring ECMO.
• At a median follow-up of 270 days, 90% of patients survived with good graft function; one late death occurred due to sepsis.

Conclusions:

• Controlled DCD lung transplantation in Canada has shown a steady increase since 2006.
• The utilization of DCD lungs for transplantation is associated with very acceptable early and intermediate clinical outcomes.
• DCD lung transplantation represents a viable strategy to expand the donor lung pool and improve transplant rates.