Donor care unit availability and organ procurement organization performance in lung transplantation

The availability and structure of donor care units (DCUs) at the Organ Procurement Organization (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 the 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. Donation after brain death donors recovered by OPOs with DCU-hospital available (odds ratio = 1.11; 95% confidence interval (CI), 1.01-1.22) and DCU-independent available (odds ratio = 1.21; 95% CI, 1.08-1.36) had higher odds of utilization than donation after brain death donors recovered by DCU-negative OPOs, whereas no significant DCU association was observed among donation after circulatory death donors. Among 18 271 lung transplant recipients, graft survival did not differ between DCU-positive and DCU-negative groups (hazard ratio = 1.03; 95% CI, 0.96-1.11) or between DCU-independent-available and DCU-hospital-available groups within the DCU-positive cohort (hazard ratio = 1.00; 95% CI, 0.87-1.15). DCU availability was associated with higher donation after brain death donor lung utilization but not recipient graft survival.