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Lungs donated after asphyxiation, drowning found suitable for transplant

Key clinical point: Lung transplant recipients had good outcomes and long-term survival in cases involving donors who died of asphyxiation or drowning.

Major finding: Pulmonary deaths were significantly less common (5.8%) among recipients whose donors had died of asphyxiation or drowning compared with other causes (9.5%; P = .02).

Data source: Retrospective registry analysis of 18,250 lung transplant recipients.

Disclosures: The authors did not report funding sources or conflicts of interest.

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Shortage of suitable donor lungs remains a problem

Dr. Jacques-Pierre Fontaine comments: The shortage of suitable donor lungs remains an important problem. Less than 20% of lungs being offered for donation are being used. The notion that asphyxiation or drowning excludes a patient from being a potential donor is widespread among some clinicians.

This extensive retrospective review of the robust UNOS Database demonstrates that recipients of lungs from donors who died from asphyxiation or drowning have similar 10-year survival and post-transplant complication rates. In carefully selected donors, these lungs may be successfully used. Furthermore, "optimization" of marginal donor lungs may become more prevalent as ex-vivo lung perfusion technology evolves.

Dr. Fontaine specializes in thoracic surgery at the Moffitt Cancer Center in Tampa, Florida.


 

References

Patients who received lung transplants from donors who died of asphyxiation or drowning had similar survival rates and clinical outcomes as those whose donors died of other causes, according to a large registry analysis in the October issue of The Annals of Thoracic Surgery.

“Asphyxiation or drowning as a donor cause of death should not automatically exclude the organ from transplant consideration,” said Dr. Bryan A. Whitson of Ohio State University, Columbus, and his associates. Donor death from asphyxiation or drowning did not significantly affect rates of airway dehiscence, transplant rejection, posttransplant stroke or dialysis, or long-term survival.

Dr. Bryan Whitson

Dr. Bryan Whitson

Lungs donated after asphyxiation or drowning should be carefully evaluated for parenchymal injury, microbial contamination, and the possibility of primary graft dysfunction, the researchers cautioned. For example, asphyxiation and drowning can alter lung surfactant levels (Ann. Thorac. Surg. 2014;98:1145-51).

The analysis included 18,205 U.S. adults who underwent lung transplantation between 1987 and 2010, including 309 patients whose donors had reportedly died from drowning or asphyxiation. Patients were identified from the UNOS/OPTN STAR (United Network for Organ Sharing/Organ Procurement and Transplantation Network Standard Transplant Analysis and Research) database, which is overseen by the U.S. Department of Health & Human Services.

Ten-year survival curves did not vary based on donor cause of death, either when analyzed individually or when asphyxiation or drowning was compared with all other causes (P = .52), the researchers said. In fact, pulmonary deaths were significantly less common (5.8%) among recipients whose donors had died of asphyxiation or drowning compared with other causes (9.5%; P = .02).

Donor death from drowning and asphyxiation also did not significantly affect rates of treatment for transplant rejection within the first year after surgery (50.8% vs. 47.4% for all other causes of donor death), or posttransplant rates of stroke (0.7% vs. 2.1%) or dialysis (5.4% vs. 5.2%), the investigators said. However, hospital length of stay averaged 0.8 days longer when donors had died of asphyxiation or drowning compared with other causes (27.3 vs. 26.5 days; P < 0.001).

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