Introduction Lung transplantation is the treatment of choice for a variety of end stage lung diseases. It offers prognostic benefit and an improvement in quality of life for carefully selected patients. There sadly remains a critical shortage of lung donors. One way to increase the donor pool, and potentially the number of lung transplants, is to utilise organs which are Donated following Circulatory Death (DCD). Here we review our experience with DCD offers received during a two-and-a-half year period.
Methods This is a retrospective study using data collected prospectively from all lung offers received between 01/2009 – 09/2011. We look at the proportion of DCD lung offers and track the fate of each of these down to transplantation. We look at the documented reasons for declining all DCD lung offers, the rate of DCD lung transplantation and the survival rate in this cohort.
Results Overall, 80 lung transplants were performed during the study period. 7 were performed using DCDs, therefore, 9% of lung transplants are from DCD donors. Survival rate at 1 year post-DCD lung transplantation is approximately 80%.
233(86%) of DCD lung offers were initially declined. Numerous reasons were documented; the most common reason given (122 donors) was due to evidence of infection. In 37 cases, the donor was unlikely to meet extubation criteria. Interestingly, 42 donors were declined as a result of having no suitable recipient on the transplant waiting list alone.
A large proportion of offers were initially accepted but not used. In 5 cases consent for transplantation was withdrawn from family, 7 cases were declined due to time/logistical factors and 10 donors were declined on inspection from the retrieval team.
Conclusion Despite offering good short term outcomes, a large number of DCD lungs are declined for a variety reasons. Donors declined due to having no suitable recipient could be reduced by increasing the number of patients on the waiting list. Increased public awareness and better communication leading up to donation may lead to fewer cases of consent being withdrawn from family. A lower threshold for attending donors who might not meet criteria may also yield more organs.