Donor Care Unit Availability and Organ Procurement Organization Performance in Lung Transplantation

The availability and structure of donor care units (DCUs) at OPO level may influence lung utilization and transplant outcomes. Adult first-time lung transplant recipients and donors with lung disposition data from January 1, 2018, through August 31, 2025 were abstracted from Scientific Registry of Transplant Recipients database. Mixed-effects logistic regression and frailty-adjusted Cox models were performed to examine lung utilization and graft survival respectively across no DCU available (DCU-negative), hospital-based DCU available (DCU-hospital available), and independent DCU available (DCU-independent available) groups. An OPO performance visualization tool was developed (http://opolung2025.com/). Among 108,502 donors, lung utilization increased stepwise by available DCU structure. DBD donors recovered by OPOs with DCU-hospital available (OR=1.11, 95% CI 1.01-1.22) and DCU-independent available (OR=1.21, 95% CI 1.08-1.36) had higher odds of utilization than DBD donors recovered by DCU-negative OPOs, whereas no significant DCU association was observed among DCD donors. Among 18,271 lung transplant recipients, graft survival did not differ between DCU-positive and DCU-negative groups (HR= 1.03, 95% CI 0.96-1.11) or between DCU-independent available and DCU-hospital available groups within the DCU-positive cohort (HR=1.00, 95% CI 0.87-1.15). DCU availability was associated with higher DBD donor lung utilization but not recipient graft survival.