New look at potential donors yields more lungs for transplant

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New look at potential donors yields more lungs for transplant

Last Updated: 2004-05-21 15:30:26 -0400 (Reuters Health)

NEW YORK (Reuters Health) - The current criteria of selecting donor

lungs suitable for transplant do not discriminate between pulmonary

injury and infection very well, and " lead to the exclusion of

potentially usable donor lungs, " researchers from the UK report in the

medical journal Thorax.

Donor lungs are in desperately short supply, they note. More than 75

percent of potential donor lungs are currently rejected for

transplantation based on largely subjective selection criteria that were

drawn up over 20 years ago and are not evidence-based. Few studies have

investigated current donor selection criteria using objective measures,

the authors point out.

Dr. P. A. Corris from the University of Newcastle upon Tyne and

colleagues evaluated the subjective decision to exclude potential lung

donors based on clinical assessment and compared this with an objective

assessment of the donor lung based on cellular and molecular measures of

infection and injury.

They studied a total of 14 donor lungs that were accepted for

transplantation and 25 that were rejected.

The team found that accepted donors were significantly younger and were

more likely to have suffered traumatic brain death compared with

rejected donors. Rejected donors were more likely to have suffered a

spontaneous brain injury, such as a stroke.

There were no differences in cellular studies that used objective

markers of infection and inflammation between accepted and rejected

donors.

Poor gas exchange was the most common reason for rejecting a potential

donor; oxygen levels were significantly higher in accepted than in

rejected donors.

" This is not surprising as the oxygenation capacity of the potential

lung provides one of the primary selection criteria, " the authors note.

However, they also point out that there is " no evidence " to support the

notion that the function of the donor lung after implantation is related

to the donor's oxygenation.

On the contrary, studies have shown that immediate organ function using

marginally acceptable lung donors with oxygenation levels below that

recommended in current guidelines is comparable to that of lungs fully

meeting the guidelines.

This suggests that donor lungs " may function very differently when

removed from the critical illness environment, " the team writes.

The current study also supports a study published in The Lancet in 2002

showing that when objectively evaluated in the laboratory, around 40

percent of rejected lungs appeared as if they might have been suitable

for transplant.

Based on these studies, Corris and colleagues say that they have now

" significantly relaxed " their donor selection criteria, as have other

large centers.

SOURCE Thorax, May 2004

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Mayo Clinic in Rochester

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