A Review of Lung Transplant Donor Acceptability Criteria

Published 1 November 2003

Jonathan B Orens, MD; Annette Boehler, MD; Marc de Perrot, MD; Marc Estenne, MD; Allan R Glanville, MD, FRACP; Shaf Keshavjee, MD; Robert Kotloff, MD; Judith Morton, MBBS, FRACP; Sean M Studer, MD; Dirk Van Raemdonck, MD, PhD; Thomas Waddel, MD, MSc, PhD, FRCSC; Gregory I Snell, MBBS, FRACP

J Heart Lung Transplant. 2003 Nov;22(11):1183-1200

• Advanced Lung Failure & Transplantation
• Consensus Document
• Publications & Journals
• Pulmonology
• Standards & Guidelines

There is a paucity of literature regarding acceptability criteria for human lung donors. Most of the currently available data are based on small, center-specific reports from the early days of lung transplantation that have not been substantiated in prospective, controlled trials or even large, uncontrolled trials. Despite the great need for suitable lung donors, only a minority of potential multiorgan donors are utilized for lung donation. With the mortality while waiting for transplantation increasing on a yearly basis, and the ever-increasing number of patients waiting for donor lungs, there is now a desperate need to expand the pool of useable donor organs for transplantation. Several small, center-specific reports have documented the efficacious use of “marginal” or less-than-optimal donor organs for this purpose, with outcomes not unlike the those from studies utilizing “optimal donors.” Other investigators have noted the importance of ultimately defining the limits of extended donor utilization.

The purpose of this report is to identify the evidence, or lack thereof, supporting the current recommendations for donor lung acceptability. In this regard a number of parameters are reviewed, including donor age, gender, cause of death, length of time on mechanical ventilation, arterial blood gas levels, radiographic changes, sputum gram-stain findings, ABO incompatibility, organ-size matching, graft ischemic time and other donor co-morbid conditions such as history of smoking, asthma and cancer.

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