Related Experiment Video
Updated: Oct 7, 2025
Study of Experimental Organ Donation Models for Lung Transplantation
Published on: March 15, 2024
Donation after circulatory death donors in lung transplantation
Thomas M Egan1, Benjamin E Haithcock1, Jason Lobo2
1Department of Surgery, UNC at Chapel Hill, Chapel Hill, NC, USA.
Insights
Donation after Circulatory Death (DCD) donors, particularly controlled DCDs, offer a promising solution to the persistent lung transplant donor shortage. Ex-vivo lung perfusion (EVLP) may enhance the utilization of DCD lungs for transplantation.
Area of Science:
- Organ Transplantation
- Thoracic Surgery
- Medical Ethics
Background:
- Lung transplantation faces a chronic shortage of suitable donors, leading to preventable deaths.
- Historically, lung donors were primarily from uncontrolled Donation after Circulatory Death (uDCD) events before the Uniform Determination of Death Act (UDDA).
- The shift to Donation after Brain Death (DBD) donors has resulted in a higher proportion of unsuitable lungs due to various complications.
Purpose of the Study:
- To evaluate the historical and potential role of Donation after Circulatory Death (DCD) donors in addressing the lung transplant donor deficit.
- To explore the impact of ex-vivo lung perfusion (EVLP) on lung utilization from DCD donors.
- To project the future significance of DCD donors in increasing lung transplant volumes.
Main Methods:
- Review of historical organ donor practices pre- and post-UDDA.
- Analysis of lung suitability from DBD donors versus potential DCD donors.
- Examination of the role and impact of ex-vivo lung perfusion (EVLP) in lung transplantation, particularly for DCD organs.
- Discussion of the ethical and logistical considerations for DCD organ recovery.
Main Results:
- Uncontrolled DCD donors (uDCDs) were the primary source before 1980; their use declined post-UDDA.
- Lungs from DBD donors frequently exhibit unsuitability for transplant due to aspiration, edema, trauma, and brain death effects.
- Controlled DCD donors (cDCDs) represent an underutilized resource for lung transplantation in the U.S. compared to kidneys and livers.
- Ex-vivo lung perfusion (EVLP) shows potential to improve the viability and transplantability of lungs from cDCDs and may be crucial for uDCD lungs.
Conclusions:
- Donation after Circulatory Death (DCD) donors, especially cDCDs, are poised to significantly increase lung transplant availability.
- Ex-vivo lung perfusion (EVLP) is a key technology for expanding the use of DCD lungs, potentially including uDCDs.
- The future of lung transplantation will likely rely heavily on maximizing the utilization of DCD organs worldwide.
Abstract:
Transplantation of any organ into a recipient requires a donor. Lung transplant has a long history of an inadequate number of suitable donors to meet demand, leading to deaths on the waiting list annually since national data was collected, and strict listing criteria. Before the Uniform Determination of Death Act (UDDA), passed in 1980, legally defined brain death in the U.S., all donors for lung transplant came from sudden death victims [uncontrolled Donation after Circulatory Death donors (uDCDs)] in the recipient's hospital emergency department. After passage of the UDDA, uDCDs were abandoned to Donation after Brain Death donors (DBDs)-perhaps prematurely. Compared to livers and kidneys, many DBDs have lungs that are unsuitable for transplant, due to aspiration pneumonia, neurogenic pulmonary edema, trauma, and the effects of brain death on lung function. Another group of donors has become available-patients with a devastating irrecoverable brain injury that do not meet criteria for brain death. If a decision is made by next-of-kin (NOK) to withdraw life support and allow death to occur by asphyxiation, with NOK consent, these individuals can have organs recovered if death occurs relatively quickly after cessation of mechanical ventilation and maintenance of their airway. These are known as controlled Donation after Circulatory Death donors (cDCDs). For a variety of reasons, in the U.S., lungs are recovered from cDCDs at a much lower rate than kidneys and livers. Ex-vivo lung perfusion (EVLP) in the last decade has had a modest impact on increasing the number of lungs for transplant from DBDs, but may have had a larger impact on lungs from cDCDs, and may be indispensable for safe transplantation of lungs from uDCDs. In the next decade, DCDs may have a substantial impact on the number of lung transplants performed in the U.S. and around the world.
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