Related Experiment Video
Updated: Aug 6, 2026
Lung Rapid Recovery Procurement Combined with Abdominal Normothermic Regional Perfusion in Controlled Donation after Circulatory Death
Published on: August 15, 2022
Donor disposition and lung utilization following "Not Expected to Progress" coding in donation after circulatory
Brian Jafari1, Lauryn Spinetta1, Vaidehi Kaza2
1Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
Background:
Donation-after-circulatory-death (DCD) lung transplantation expands access for waitlisted patients, but uncertainty regarding donor progression may lead centers to decline offers using refusal code 753 ("DCD donor neurological function/not expected to arrest"). We sought to characterize the disposition of these donors and center practices in their allocation.
Methods:
Using national registry match-run data from January 2021 through June 2024 linked with Organ Procurement and Transplant Network (OPTN) transplant data, we identified DCD donors from whom lung offers were generated. Donors declined at least once with code 753 were classified as not expected to progress (NEP). Donor progression, organ procurement, and post-transplant survival were compared with standard DCD (S-DCD) donors.
Results:
Among 6,140 NEP donors, 3,687 (60.0%) progressed to circulatory death and had at least one organ procured. Among progressed NEP donors, lungs were recovered from 908 donors (24.6%), and 670 donors ultimately yielded at least one transplanted lung. Post-transplant survival did not differ between linked recipients of NEP and S-DCD lungs (log-rank p = 0.15).
Conclusions:
Many DCD donors declined using code 753 ultimately progressed after withdrawal of life-sustaining therapy, with lungs recovered in only a minority of these cases. The uncertainty surrounding donor progression may restrict access to DCD lung transplantation for waitlisted patients. Standardized DCD assessment, donor management, and policy guidance may help centers manage uncertainty when fielding DCD offers.
