Maximizing Lung Transplant Donor Utilization: Developing a Lobar Donor Repository Guided by Chest Computed Tomography...

This study develops a visual scoring system based on chest computed tomography (CT) findings to assess donor lung function and explores its use for brain-dead donors.

We conducted a retrospective cohort study of 151 donors after brain death managed by our local Organ Procurement Organization from January 1 to June 30, 2024. A multidisciplinary team developed a chest CT evaluation protocol based on Fleischner Society guidelines. Lung lesions were scored lobe-by-lobe for statistical analysis.

Of 151 potential donors, 56 (37.09%) underwent lung transplantation. Transplanted lungs had a higher proportion of blood type O, better oxygenation index, lower C-reactive protein and procalcitonin level, and lower CT scores compared to non-transplanted lungs. A higher total lung score (TLS) was strongly and negatively associated with lung utilization (OR 0.643, P < .001). ROC curve analysis indicated good discriminative ability for the TLS alone (AUC = 0.803). Our findings establish that chest CT visual scoring is a valuable univariable tool for assessing lungs from brain-dead donors. Based on the CT scoring results, the overall utilization rate of potential lung lobes reached 79.22%.

In the evaluation of donor lungs, a high TLS demonstrates a significant negative univariable association with lung utilization rates and exhibits good univariable diagnostic accuracy. The TLS has the potential to serve as a powerful and practical screening tool for donor lung assessment. Our findings suggest that chest CT visual scoring holds potential importance in assessing lungs from brain-dead donors and provides meaningful insights into the evaluation of donor lung lobes. However, further studies with larger sample sizes are required to explore these findings in greater depth.