Resources

Published 19 November 2024

• OPTN Comment

The International Society for Heart and Lung Transplantation (ISHLT) welcomes the opportunity to comment on the OPTN proposal to "Modify Lung Donor Testing Data Collection." The proposal seeks to promote efficiency of lung allocation by making changes in OPTN data collection to make it easier for lung transplant programs to consider donor offers. Donor predicted total lung capacity (pTLC) and Peak Inspiratory Pressure (PIP) would be added, and smoking history would be modified to increase granularity. Instead of collecting data on cigarette use and >20 pack year use, the new data collected would include the actual donor pack-years in addition to information regarding vaping and marijuana smoking. Programs would be able to list acceptable donor pTLC ranges for candidates, and they would be able to use offer filters for donor cigarette pack years.

We believe the additional data collection is extensive and may place a burden on organ procurement organizations (OPOs), but the additional information will help programs make more informed decisions when considering donors. The ability to screen donors based on pTLC will decrease provisional acceptances which will reduce workload for transplant centers and increase organ placement efficiency. The offer filters for cigarette use will also increase efficiency.

We recommend more guidance about how uncertainties in history should be documented. Although there is an “unknown” option for history of smoking cigarettes, vaping, and smoking marijuana, we suggest an option to quantify cigarette smoking or specify that quantity is “unknown,” “approximate,” “best estimate,” “confirmed,” etc. Additionally, we recommend collecting data on cigar or pipe smoking and collecting quantification of vaping, marijuana use, and cigar or pipe smoking. Examples of quantification could include “joint years” for marijuana or “vape years” for vaping. Offer filters could be added for this additional data to further increasing efficiency of organ placement.

The use of predicted total lung capacity is a welcome addition. The current system only allows size screening by using donor height without including age and gender. The pTLC calculation will reduce workload for transplant centers by eliminating the need to manually calculate pTLC for all offers. It also will improve efficiency as centers will often provisionally accept, and only when the center is primary will they perform the pTLC calculations. Often this delays the decision to decline for unacceptable size. We also suggest offer filters that may be triggered if specific testing cannot be completed such as bronchoscopy, CT scan, or echocardiogram.

Finally, we strongly recommend collecting data related to methamphetamine use. Methamphetamine use disorder is becoming more common and can lead to pulmonary hypertension which may not otherwise be evident. Avoidance of donors with occult pulmonary hypertension from methamphetamine can ultimately improve recipient outcomes.