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Upgrading Donor Lung Quality to Improve Availability

ly half of the listed patients were on the list more than two years before receiving their transplant.

The authors noted that this trend worsens each year. The number of new additions to the transplant list is nearly double the number of patients who receive lungs.

According to the SALT lung management protocol, donor organs from brain dead patients (average age 36) were classified according to lungs’ oxygenation ability, whether lung tissue has collapsed or the presence of pulmonary edema (abnormal collection of fluid in the lung).

During the program, certain donor organs previously classified as poor were subjected to specialized clinical maneuvers to improve lung quality. These procedures included bronchoscopic airway clearing of secretions, new mechanical ventilation strategies and use of diuretics to increase secretion of fluid.

As a result of these efforts, 135 organs were upgraded from poor to usable, making them eligible for transplantation.

“A key strategy for increasing the number of usable donor lungs in our study was modifying donor criteria by reassessing oxygenation, chest radiography and bronchoscopic findings as absolute criteria after active donor management,” said Dr. Angel.

The authors concluded that implementing a similar donor-management program on a large scale at organ banks around the U.S., with a procurement rate approaching 25 percent, would nearly double the number of lung transplantation procedures, significantly decrease lengthy wait times and potentially eliminate many of the deaths that occur among patients awaiting lung transplantation.

In an editorial on the research in the same issue of the journal, Andrew C. Chang, M.D., of the University of Michigan Medical Center, and Jonathan B. Orens, M.D., of Johns Hopkins University School of Medicine, wrote: “It is intriguing that although organ offer rates increased to over 50 percent of consented donors, tr
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