Elsevier

Transplantation Proceedings

Volume 41, Issue 8, October 2009, Pages 3284-3289
Transplantation Proceedings

Organ donation and preservation
Pulmonary Recruitment Protocol For Organ Donors: A New Strategy to Improve the Rate of Lung Utilization

https://doi.org/10.1016/j.transproceed.2009.08.041Get rights and content

Abstract

Because lung transplantation is the only effective therapy for terminal respiratory failure, the demand for donor lungs has increased steadily. However, the number of donors has remained fairly constant over the years, which results in an increasing duration of waiting for lung transplantation. To overcome the lack of organs, various strategies have been developed by transplant centers including use of marginal donors. To increase the lung utilization rate in multiorgan donors, we implemented a simple lung recruitment protocol involving a brief period of controlled sustained inflation. In 2005, the lung utilization rate in the transplant program at our institution was only 20% in multiorgan donors. With the lung recruitment protocol, the rate of lung utilization for transplantation increased to 33%, in 2006, 24% in 2007, and 24% in 2008. Following the lung recruitment protocol, the arterial oxygen tension/fraction of inspired oxygen ratio increased to greater than 15% in more than 40% of donors. We were able to improve gas exchange sufficiently that as many as two-thirds of the lungs were suitable for transplantation. During the protocol, no complications were reported, and no patient became hemodynamically unstable, precluding organ procurement. We believe that optimization of multiorgan donor management with simple interventions may improve oxygenation, reducing the number of inadequate donor lungs and increasing the overall donor pool and organ availability.

Section snippets

Lung Transplantation and Limited Donor Pool

The number of centers reporting lung transplantation had been relatively stable to 1997; however, annual activity has increased by 47% since 1999, with the number of procedures reaching a high of 2169 in 2005.1 Over the past decade, however, the number of patients on the waiting list has increased progressively and now far exceeds the number of available organs.1 In the United States, the number of candidates on the lung transplant waiting list increased by 11% from 1997 to 2006.2 Time on the

Pulmonary Recruitment Protocol

Our lung transplantation program was created in 1997. Since then, we have performed more than 300 lung transplantations. Our lung transplantation center is the only program serving the Province of Quebec, with 8 million inhabitants and a vast territory nearly 3 times the size of France or Texas. Québec-Transplant is the sole provincial organization responsible for coordinating organ donation, allocation, and procurement in Quebec (Fig. 1). Organs are allocated to transplant programs in Quebec

Results

Since 2001, the number of multiorgan donors in Quebec has varied from 127 in 2002 to a maximum of 151 in 2008 (Fig. 2). During the same period, the number of patients with end-stage lung disease awaiting transplantation increased from 53 to 82. However, despite the increased demand, the number of available organs and of lung transplantation procedures have not increased sufficiently to meet demand. Although 25 to 30 transplantation procedures were being performed annually, 6 to 16 patients died

Discussion

Over the years, organ donor availability has continued to be a serious problem in Quebec, with a relatively stable pool of potential suitable organs averaging 140 donors for about 8 million population. While the demand for transplantation in patients with end-stage lung disease has increased dramatically, the insufficient supply of donor lungs has resulted in prolonged time on the waiting list, with a substantial number of deaths. The demand for donor lungs clearly exceeds the availability in

Acknowledgments

We thank Michel Carrier, MD, Micheline Lyras, BSc N, Diane Gagnon, RN, and the entire staff from Québec Transplant for their continued support.

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This study was supported by the Alfonso Minicozzi and Family Chair in Thoracic Surgery and Lung Transplantation, University of Montréal, Montréal, Québec, Canada.

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