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Updated: May 29, 2026
Study of Experimental Organ Donation Models for Lung Transplantation
Published on: March 15, 2024
Extended Criteria Donor Use in Lung Transplants From Donation After Controlled Circulatory Death
Wenxi Zhang1, Chenyu Zhang1, Hanqun Liu1
1Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China.
Insights
Using extended criteria donors (ECD) for lung transplants from controlled donation after cardiac death (cDCD) is safe. Donor lungs meeting expanded criteria show similar survival and outcomes to standard criteria donors in cDCD lung transplantation.
Area of Science:
- Cardiology
- Pulmonology
- Transplantation Medicine
Background:
- Institutions commonly use donation after brain death (DBD) criteria for controlled donation after cardiac death (cDCD) lung retrieval.
- The efficacy of utilizing extended criteria donors (ECD) for cDCD lung transplantation is not well-established.
Purpose of the Study:
- To evaluate the safety and efficacy of using ECD lungs from cDCD donors in lung transplantation.
- To compare short- and long-term survival and postoperative outcomes between standard criteria donor (SCD) and ECD groups in cDCD lung recipients.
Main Methods:
- A query of the United Network for Organ Sharing (UNOS) database for adult lung transplants from cDCD donors between May 2005 and March 2022.
- ECDs were defined by criteria including age ≥55 years, PaO2:FiO2 ≤300, smoking history ≥20 pack-years, diabetes, or purulent secretions.
- Recipients were categorized into SCD and ECD groups for comparative analysis of survival and postoperative events.
Main Results:
- Analysis of 827 lung transplants revealed no significant difference in 5-year survival between SCD and ECD groups (P = .56).
- No significant variations were observed in 30-day, 90-day, or 1-year mortality, nor in postoperative outcomes like hospital stay, ventilator support duration, reintubation rates, primary graft dysfunction (PGD), acute rejection, or dialysis.
- None of the five donor factors used to define ECDs were independently linked to recipient survival in cDCD lung transplantation.
Conclusions:
- Utilizing donor lungs that exceed standard DBD criteria appears to be a safe approach in cDCD lung transplantation.
- Current donor selection criteria may require refinement for optimal cDCD lung retrieval.
- Further research is needed to establish specific DCD criteria for standard lung retrieval.
Background:
Most institutions apply the criteria for controlled donation after cardiac death (cDCD) lung retrieval identical to the criteria for donation after brain death (DBD). The availability of extended criteria donor (ECD) in lung transplants from cDCD remains unclear.
Methods:
The United Network for Organ Sharing (UNOS) database was queried for adult lung transplants from cDCD, from May 03, 2005, to March 15, 2022. ECDs were defined by one or more items at variance from standard criteria: age 55 years or more, PaO2:FiO2 300 or less, smoking 20 pack-years or more, diabetes, or purulent secretions upon bronchoscopy. Recipients were divided into the standard criteria donor (SCD) group and the ECD group, and assessed for short- and long-term survival and postoperative events.
Results:
Among 827 records, the SCD and ECD group showed no differences in 5-year (P = .56) survival. No significant differences were found in 30-day, 90-day, 1-year mortality and postoperative outcomes before discharge, whether in length of hospital stay, rate of ventilator support for >48 hours or reintubation, incidence of grade 3 PGD 72 hours posttransplant, acute rejection, or dialysis. None of the 5 donor factors used as criteria for lung retrieval was independently associated with cDCD recipient survival.
Conclusions:
Using donor lungs that extend the DBD criteria may be a safe strategy in cDCD lung transplantation. However, the current criteria may not be a perfect fit for cDCD lung retrieval. The specific DCD criteria for standard lung retrieval need to be determined.
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