The Effect Of A Two-Surgeon Review System On Donor Offers In Lung Transplantation At A High-Volume Center

In an effort to enhance donor lung utilization, our center implemented a two-surgeon review system whereby donor lungs declined by the primary on-call surgeon are reassessed by a second surgeon. We evaluated the impact of this model on transplant volume and clinical outcomes.

A single-center retrospective review was conducted of lung transplant (LTx) recipients between August 2022 and September 2024. Outcomes were compared between recipients receiving lungs initially accepted and those accepted after second review. Primary endpoints included primary graft dysfunction (PGD) grade 3 at 72 hours, postoperative extracorporeal membrane oxygenation (ECMO), time to extubation, length of stay, and survival.

During the 2-year study period, 428 LTx were performed; 34 (8%) used donors accepted after second review. Among 880 initially declined offers, 57 were accepted and 34 transplanted. EVLP utilization was similar between groups (38.2% vs 32.9%; p=0.666). Donor and recipient characteristics were comparable. Rates of PGD grade 3 (11.8% vs 12.9%), postoperative ECMO (5.9% vs 5.3%), time to extubation (70 vs 52 hours), ICU stay (6 vs 6 days), hospital stay (26 vs 23 days) and overall survival were similar between groups.

Implementation of this two-surgeon review system increased transplant volume by 8.6% without compromising early outcomes.