help button home button
AJRCCM
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by GABBAY, E.
Right arrow Articles by SNELL, G. I.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by GABBAY, E.
Right arrow Articles by SNELL, G. I.

Am. J. Respir. Crit. Care Med., Volume 160, Number 1, July 1999, 265-271

Maximizing the Utilization of Donor Organs Offered for Lung Transplantation

ELI GABBAY, TREVOR J. WILLIAMS, ANNE P. GRIFFITHS, LOUISE M. MACFARLANE, TOM C. KOTSIMBOS, DONALD S. ESMORE, and GREGORY I. SNELL

Heart and Lung Replacement Services and Department of Respiratory Medicine, Alfred Hospital, Prahran, Victoria, Australia

The number of patients awaiting lung transplantation (LT) and waiting time for surgery is increasing. In Australia, LT rates are 4.6/million population/yr, which despite low organ donation rates, are the highest published in the world. The Australian organ allocation system allows identification of marginal donors and therapeutic manipulation where appropriate. This study aims to assess the impact of utilization of marginal donors and aggressive donor management. A comparison between published donor criteria and local practice is made, allowing assessment of the effect of using marginal donors on outcome. Donor management included antibiotic therapy, strict fluid management, physiotherapy, bronchoscopy and bronchial toilet, and alteration of ventilatory settings including initiation of pressure support. Blood gases were repeated to assess the results of interventions. Between January 1, 1995 and May 31, 1998, we performed 140 transplants from 112 of 219 (51%) lung donor offers. Of these donors, 48 (43%) satisfied all published criteria for suitable donor organs (Group 1 = ideal donors) and 64 (57%) did not (Group 2 = marginal donors). Criteria breached by the marginal donors were: an initial ratio of arterial oxygen pressure to fraction of inspired oxygen (PaO2/FIO2) < 300 mm Hg (n = 20), abnormal radiology (n = 39), pulmonary infection (n = 24), 20 pack-years smoking (n = 5) and age > 55 yr (n = 4). Therapeutic manipulation resulted in improvement in the PaO2/FIO2 ratio in 20 donors (Group 3) who would not otherwise have been used. Immediate and 24 h postoperative gas exchange and length of intensive care unit (ICU) stay was not different for recipients from donors from all three groups. Overall survival was 94% at 30 d, 83% at 1 yr, 70% at 2 yr, and 62% at 3 yr and was not significantly different from the three groups. We conclude that organ utilization can be maximized by therapeutic manipulation and utilization of marginal donors without compromising results from transplantation.




This article has been cited by other articles:


Home page
 Br J AnaesthHome page
D. R. McIlroy, D. V. Pilcher, and G. I. Snell
Does anaesthetic management affect early outcomes after lung transplant? An exploratory analysis
Br. J. Anaesth., April 1, 2009; 102(4): 506 - 514.
[Abstract] [Full Text] [PDF]

Home page
 Proc Am Thorac SocHome page
D. Van Raemdonck, A. Neyrinck, G. M. Verleden, L. Dupont, W. Coosemans, H. Decaluwe, G. Decker, P. De Leyn, P. Nafteux, and T. Lerut
Lung Donor Selection and Management
Proceedings of the ATS, January 15, 2009; 6(1): 28 - 38.
[Abstract] [Full Text] [PDF]

Home page
 Eur. J. Cardiothorac. Surg.Home page
A. Zuin, G. Marulli, M. Loy, and F. Rea
Clamshell approach for lung harvest in donor with previous aortic valve substitution
Eur. J. Cardiothorac. Surg., January 1, 2009; 35(1): 181 - 182.
[Abstract] [Full Text] [PDF]

Home page
 Am J Crit CareHome page
M.-K. Song, A. De Vito Dabbs, S. M. Studer, and S. E. Zangle
Course of Illness after the Onset of Chronic Rejection in Lung Transplant Recipients
Am. J. Crit. Care., May 1, 2008; 17(3): 246 - 253.
[Abstract] [Full Text] [PDF]

Home page
 ThoraxHome page
T J Williams and J W Wilson
Challenges in pulmonary fibrosis: 7 {middle dot} Novel therapies and lung transplantation
Thorax, March 1, 2008; 63(3): 277 - 284.
[Abstract] [Full Text] [PDF]

Home page
 Card Surg AdultHome page
A. Y. Sheikh, M. P. Pelletier, and R. C. Robbins
Heart-Lung and Lung Transplantation
Card. Surg. Adult, January 1, 2008; 3(2008): 1579 - 1608.
[Full Text]

Home page
 Ann. Thorac. Surg.Home page
Y. Toyoda and K. R. McCurry
Prior Cardiac Surgery is Not a Contraindication for Lung Donor
Ann. Thorac. Surg., July 1, 2007; 84(1): 314 - 316.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
T. Oto, R. Venkatachalam, Y. S. Morsi, S. Marasco, A. Pick, M. Rabinov, and F. Rosenfeldt
A reinforced sternal wiring technique for transverse thoracosternotomy closure in bilateral lung transplantation: From biomechanical test to clinical application
J. Thorac. Cardiovasc. Surg., July 1, 2007; 134(1): 218 - 224.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
D. V. Pilcher, G. M. Auzinger, B. Mitra, D. V. Tuxen, R. F. Salamonsen, A. R. Davies, T. J. Williams, and G. I. Snell
Predictors of independent lung ventilation: An analysis of 170 single-lung transplantations
J. Thorac. Cardiovasc. Surg., April 1, 2007; 133(4): 1071 - 1077.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
M. De Perrot, T. K. Waddell, Y. Shargall, A. F. Pierre, E. Fadel, K. Uy, C. Chaparro, M. Hutcheon, L. G. Singer, and S. Keshavjee
Impact of donors aged 60 years or more on outcome after lung transplantation: Results of an 11-year single-center experience
J. Thorac. Cardiovasc. Surg., February 1, 2007; 133(2): 525 - 531.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
T. Oto, B. J. Levvey, H. Whitford, A. P. Griffiths, T. Kotsimbos, T. J. Williams, and G. I. Snell
Feasibility and Utility of a Lung Donor Score: Correlation With Early Post-Transplant Outcomes
Ann. Thorac. Surg., January 1, 2007; 83(1): 257 - 263.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
P. Botha, D. Trivedi, C. P. Searl, P. A. Corris, S. V.B. Schueler, and J. H. Dark
Differential Pulmonary Vein Gases Predict Primary Graft Dysfunction
Ann. Thorac. Surg., December 1, 2006; 82(6): 1998 - 2002.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
T. Oto, A. P. Griffiths, B. J. Levvey, T. J. Williams, and G. I. Snell
Unilateral radiographic abnormalities after bilateral lung transplantation: Exclusion from the definition of primary graft dysfunction?
J. Thorac. Cardiovasc. Surg., December 1, 2006; 132(6): 1441 - 1446.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
T. Oto, A. P. Griffiths, F. Rosenfeldt, B. J. Levvey, T. J. Williams, and G. I. Snell
Early Outcomes Comparing Perfadex, Euro-Collins, and Papworth Solutions in Lung Transplantation
Ann. Thorac. Surg., November 1, 2006; 82(5): 1842 - 1848.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
A. C. Chang and J. B. Orens
Are there more lungs available than currently meet the eye?
Am. J. Respir. Crit. Care Med., September 15, 2006; 174(6): 624 - 625.
[Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
L. F. Angel, D. J. Levine, M. I. Restrepo, S. Johnson, E. Sako, A. Carpenter, J. Calhoon, J. E. Cornell, S. G. Adams, G. B. Chisholm, et al.
Impact of a Lung Transplantation Donor-Management Protocol on Lung Donation and Recipient Outcomes
Am. J. Respir. Crit. Care Med., September 15, 2006; 174(6): 710 - 716.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
T. Oto, A. P. Griffiths, B. J. Levvey, D. V. Pilcher, T. J. Williams, and G. I. Snell
Definitions of primary graft dysfunction after lung transplantation: Differences between bilateral and single lung transplantation
J. Thorac. Cardiovasc. Surg., July 1, 2006; 132(1): 140 - 147.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
P. Botha, D. Trivedi, C. J. Weir, C. P. Searl, P. A. Corris, J. H. Dark, and S. V.B. Schueler
Extended donor criteria in lung transplantation: Impact on organ allocation
J. Thorac. Cardiovasc. Surg., May 1, 2006; 131(5): 1154 - 1160.
[Abstract] [Full Text] [PDF]

Home page
 Crit Care NurseHome page
K. J. O'Connor, K. E. Wood, and K. Lord
Intensive Management of Organ Donors to Maximize Transplantation
Crit. Care Nurse, April 1, 2006; 26(2): 94 - 100.
[Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
T. Oto, M. Rabinov, J. Negri, S. Marasco, M. Rowland, A. Pick, G. Snell, F. Rosenfeldt, and D. Esmore
Techniques of Reconstruction for Inadequate Donor Left Atrial Cuff in Lung Transplantation
Ann. Thorac. Surg., April 1, 2006; 81(4): 1199 - 1204.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
P. Wierup, A. Haraldsson, F. Nilsson, L. Pierre, H. Schersten, M. Silverborn, T. Sjoberg, U. Westfeldt, and S. Steen
Ex Vivo Evaluation of Nonacceptable Donor Lungs
Ann. Thorac. Surg., February 1, 2006; 81(2): 460 - 466.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
T. Oto, M. Rabinov, A. P. Griffiths, H. Whitford, B. J. Levvey, D. S. Esmore, T. J. Williams, and G. I. Snell
Unexpected donor pulmonary embolism affects early outcomes after lung transplantation: A major mechanism of primary graft failure?
J. Thorac. Cardiovasc. Surg., November 1, 2005; 130(5): 1446 - 1446.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
T. Oto, B. J. Levvey, D. V. Pilcher, M. J. Bailey, and G. I. Snell
Evaluation of the oxygenation ratio in the definition of early graft dysfunction after lung transplantation
J. Thorac. Cardiovasc. Surg., July 1, 2005; 130(1): 180 - 186.
[Abstract] [Full Text] [PDF]

Home page
 Eur. J. Cardiothorac. Surg.Home page
D. Lardinois, M. Banysch, S. Korom, S. Hillinger, V. Rousson, A. Boehler, R. Speich, and W. Weder
Extended donor lungs: eleven years experience in a consecutive series
Eur. J. Cardiothorac. Surg., May 1, 2005; 27(5): 762 - 767.
[Abstract] [Full Text] [PDF]

Home page
 NEJMHome page
K. E. Wood, B. N. Becker, J. G. McCartney, A. M. D'Alessandro, and D. B. Coursin
Care of the Potential Organ Donor
N. Engl. J. Med., December 23, 2004; 351(26): 2730 - 2739.
[Full Text] [PDF]

Home page
 Eur Respir JHome page
M. de Perrot, W. Weder, G.A. Patterson, and S. Keshavjee
Strategies to increase limited donor resources
Eur. Respir. J., March 1, 2004; 23(3): 477 - 482.
[Abstract] [Full Text] [PDF]

Home page
 Eur. J. Cardiothorac. Surg.Home page
V. S. Avlonitis, A. Krause, L. Luzzi, H. Powell, J. A. Phillips, P. A. Corris, F. K. Gould, and J. H. Dark
Bacterial colonization of the donor lower airways is a predictor of poor outcome in lung transplantation
Eur. J. Cardiothorac. Surg., October 1, 2003; 24(4): 601 - 607.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
C. J. McNamee, D. L. Modry, D. Lien, and A. A. Conlan
Drowned donor lung for bilateral lung transplantation
J. Thorac. Cardiovasc. Surg., September 1, 2003; 126(3): 910 - 912.
[Full Text] [PDF]

Home page
 Am. J. Respir. Cell Mol. Bio.Home page
M. de Perrot, S. Fischer, M. Liu, Y. Imai, S. Martins, S. Sakiyama, T. Tabata, X.-H. Bai, T. K. Waddell, B. L. Davidson, et al.
Impact of Human Interleukin-10 on Vector-Induced Inflammation and Early Graft Function in Rat Lung Transplantation
Am. J. Respir. Cell Mol. Biol., May 1, 2003; 28(5): 616 - 625.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
M. de Perrot, M. Liu, T. K. Waddell, and S. Keshavjee
Ischemia-Reperfusion-induced Lung Injury
Am. J. Respir. Crit. Care Med., February 15, 2003; 167(4): 490 - 511.
[Abstract] [Full Text] [PDF]

Home page
 Card Surg AdultHome page
L. B. Balsam, D. D. Yuh, R. C. Robbins, and B. A. Reitz
Heart-Lung and Lung Transplantation
Card. Surg. Adult, January 1, 2003; 2(2003): 1461 - 1490.
[Full Text]

Home page
 ChestHome page
D. Weill
Donor Criteria in Lung Transplantation* : An Issue Revisited
Chest, June 1, 2002; 121(6): 2029 - 2031.
[Abstract] [Full Text] [PDF]

Home page
 J Intensive Care MedHome page
M. M. Chakinala, M. H. Kollef, and E. P. Trulock
Critical Care Aspects of Lung Transplant Patients
J Intensive Care Med, January 1, 2002; 17(1): 8 - 33.
[Abstract] [PDF]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Proc. Am. Thorac. Soc. Am. J. Respir. Cell Mol. Biol.
Copyright © 1999 American Thoracic Society 		  Red In Translatin