Related Experiment Video
Updated: Jan 8, 2026
Study of Experimental Organ Donation Models for Lung Transplantation
Published on: March 15, 2024
Donation after Circulatory Death Donors Are Associated With Increased 1-Year Mortality After Lung Transplantation: A
Amit Banga1, Brandon A Guenthart2, Song Zhang3
1Departments of Medicine, Lung Transplant Program, Stanford University, Stanford, California, USA.
Insights
Lung transplants using donation after circulatory death (DCD) donors show higher one-year mortality. A new recipient risk score, based on age, ICU admission, GFR, and organ time, predicts outcomes for DCD lung transplants.
Area of Science:
- Transplantation research
- Organ donation science
- Medical statistics
Background:
- Donation after circulatory death (DCD) donor utilization is rising in lung transplantation.
- Increased DCD donor use necessitates risk stratification for recipients.
- Current study addresses risk factors for DCD lung transplant outcomes.
Purpose of the Study:
- To risk-stratify lung transplant recipients utilizing DCD donors.
- To identify factors associated with one-year mortality in DCD lung transplant recipients.
- To develop a predictive score for DCD lung transplant outcomes.
Main Methods:
- Review of the UNOS database for adult lung transplants (LT) using DCD donors (2017-2022).
- Analysis of one-year mortality as the primary dependent variable.
- Cox proportional hazard analysis with bootstrap validation to identify risk factors.
Main Results:
- DCD donor proportion increased from 3.7% to 7.6% (2017-2022).
- DCD lung transplants had higher one-year mortality (13.9% vs. 10.7%).
- Risk factors for mortality include recipient age >65, ICU admission, eGFR <75, and organ ischemic time >7 hours.
Conclusions:
- DCD donor utilization in lung transplantation is linked to worse one-year survival.
- A novel recipient risk score effectively predicts one-year mortality.
- The score incorporates recipient age, ICU status, GFR, and organ ischemic time.
Background:
The use of donation after circulatory death (DCD) donors has significantly increased in recent years. The current study sought to risk-stratify transplants where DCD donors are utilized.
Methods:
We reviewed the UNOS database for adult patients who underwent lung transplantation (LT) using DCD donors between 2017 and 2022 (n = 948, 6.31% of all LT). One-year mortality was the primary dependent variable.
Results:
The proportion of DCD donors is increasing (3.7% in 2017 to 7.6% in 2022, p < 0.001) and is associated with significantly higher 1-year mortality (13.9% vs. 10.7% among recipients of brain dead donors; p = 0.003). On Cox proportional hazard analysis with bootstrap validation, recipient age > 65 years (adjusted hazards ratio, 95% CI: 1.51, 1.05-2.2; p = 0.028), admission to the ICU at the time of transplant (2.11, 1.34-3.31; p = 0.001), estimated GFR < 75 mL/min/1.73 m2 at the time of transplant (1.81, 1.23-2.67; p = 0.003), and organ out of body time >7 h (2.02, 1.39-2.94; p < 0.001) are associated with 1-year mortality. A composite variable, the recipient risk score, based on the number of above risk factors, is strongly associated with 1-year mortality.
Conclusions:
The utilization of DCD donors is associated with worse 1-year mortality after LT. The recipient risk score based on the four simple-to-use recipient and procedure-related variables strongly predicts outcomes.
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