The University of Minnesota Donor Lung Quality Index: A Consensus-Based Scoring Application Improves Donor Lung Use

Gabriel Loor, David M. Radosevich, Rosemary F Kelly, Irena Cich, Timothy S. Grabowski, Christopher Lyon, J. Michael Morrow, Edward M. Bender, Joanne L Billings, Marshall I Hertz

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background A simplified and consensus-based donor scoring process could improve donor lung use. Methods To develop the University of Minnesota Donor Lung Quality Index (UMN-DLQI), we used expert opinion to create an online survey that ranked 17 lung donor and recipient factors and graded their importance on a scale of 0 to 10. To arrive at consensus-based weights for each of the 17 factors, we used magnitude estimation (ME) methods. We performed receiver operating characteristic (ROC) analyses to evaluate predictive value. An application (app) was developed to simplify the scoring process. A second review process was instituted for every donor offer with an UMN-DLQI score greater than 40 as of September 2014 (post–donor score era). Results Worldwide, 11 transplantation centers (including ours) completed our survey. Results showed strong consensus among transplantation physicians across disparate practices. UMN-DLQI scores greater than 40 provided a sensitivity of 89%, a specificity of 55%, and a positive predictive value of 52% for donor offer acceptance. Number of transplants (63 versus 48) and donor lung use (15.1% versus 8.9%; p = 0.02) were significantly better in the post–donor score era without a penalty in transplantation outcomes. There was a trend toward a lower incidence of any primary graft dysfunction within 72 hours (40% versus 75%; p = 0.06) with a UMN-DLQI greater than 40 but no difference in 30-day or 1-year survival. Conclusions The UMN-DLQI scoring app is a simple tool for describing the attributes of a donor lung offer. More attention to scores greater than 40 safely improved donor lung use at a single institution.

Original languageEnglish (US)
Pages (from-to)1156-1165
Number of pages10
JournalAnnals of Thoracic Surgery
Volume102
Issue number4
DOIs
StatePublished - Oct 1 2016

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Tissue Donors
Lung
Transplantation
Primary Graft Dysfunction
Expert Testimony
ROC Curve
Physicians
Transplants
Weights and Measures
Incidence

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The University of Minnesota Donor Lung Quality Index : A Consensus-Based Scoring Application Improves Donor Lung Use. / Loor, Gabriel; Radosevich, David M.; Kelly, Rosemary F; Cich, Irena; Grabowski, Timothy S.; Lyon, Christopher; Michael Morrow, J.; Bender, Edward M.; Billings, Joanne L; Hertz, Marshall I.

In: Annals of Thoracic Surgery, Vol. 102, No. 4, 01.10.2016, p. 1156-1165.

Research output: Contribution to journalArticle

Loor, Gabriel ; Radosevich, David M. ; Kelly, Rosemary F ; Cich, Irena ; Grabowski, Timothy S. ; Lyon, Christopher ; Michael Morrow, J. ; Bender, Edward M. ; Billings, Joanne L ; Hertz, Marshall I. / The University of Minnesota Donor Lung Quality Index : A Consensus-Based Scoring Application Improves Donor Lung Use. In: Annals of Thoracic Surgery. 2016 ; Vol. 102, No. 4. pp. 1156-1165.
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abstract = "Background A simplified and consensus-based donor scoring process could improve donor lung use. Methods To develop the University of Minnesota Donor Lung Quality Index (UMN-DLQI), we used expert opinion to create an online survey that ranked 17 lung donor and recipient factors and graded their importance on a scale of 0 to 10. To arrive at consensus-based weights for each of the 17 factors, we used magnitude estimation (ME) methods. We performed receiver operating characteristic (ROC) analyses to evaluate predictive value. An application (app) was developed to simplify the scoring process. A second review process was instituted for every donor offer with an UMN-DLQI score greater than 40 as of September 2014 (post–donor score era). Results Worldwide, 11 transplantation centers (including ours) completed our survey. Results showed strong consensus among transplantation physicians across disparate practices. UMN-DLQI scores greater than 40 provided a sensitivity of 89{\%}, a specificity of 55{\%}, and a positive predictive value of 52{\%} for donor offer acceptance. Number of transplants (63 versus 48) and donor lung use (15.1{\%} versus 8.9{\%}; p = 0.02) were significantly better in the post–donor score era without a penalty in transplantation outcomes. There was a trend toward a lower incidence of any primary graft dysfunction within 72 hours (40{\%} versus 75{\%}; p = 0.06) with a UMN-DLQI greater than 40 but no difference in 30-day or 1-year survival. Conclusions The UMN-DLQI scoring app is a simple tool for describing the attributes of a donor lung offer. More attention to scores greater than 40 safely improved donor lung use at a single institution.",
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AU - Radosevich, David M.

AU - Kelly, Rosemary F

AU - Cich, Irena

AU - Grabowski, Timothy S.

AU - Lyon, Christopher

AU - Michael Morrow, J.

AU - Bender, Edward M.

AU - Billings, Joanne L

AU - Hertz, Marshall I

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N2 - Background A simplified and consensus-based donor scoring process could improve donor lung use. Methods To develop the University of Minnesota Donor Lung Quality Index (UMN-DLQI), we used expert opinion to create an online survey that ranked 17 lung donor and recipient factors and graded their importance on a scale of 0 to 10. To arrive at consensus-based weights for each of the 17 factors, we used magnitude estimation (ME) methods. We performed receiver operating characteristic (ROC) analyses to evaluate predictive value. An application (app) was developed to simplify the scoring process. A second review process was instituted for every donor offer with an UMN-DLQI score greater than 40 as of September 2014 (post–donor score era). Results Worldwide, 11 transplantation centers (including ours) completed our survey. Results showed strong consensus among transplantation physicians across disparate practices. UMN-DLQI scores greater than 40 provided a sensitivity of 89%, a specificity of 55%, and a positive predictive value of 52% for donor offer acceptance. Number of transplants (63 versus 48) and donor lung use (15.1% versus 8.9%; p = 0.02) were significantly better in the post–donor score era without a penalty in transplantation outcomes. There was a trend toward a lower incidence of any primary graft dysfunction within 72 hours (40% versus 75%; p = 0.06) with a UMN-DLQI greater than 40 but no difference in 30-day or 1-year survival. Conclusions The UMN-DLQI scoring app is a simple tool for describing the attributes of a donor lung offer. More attention to scores greater than 40 safely improved donor lung use at a single institution.

AB - Background A simplified and consensus-based donor scoring process could improve donor lung use. Methods To develop the University of Minnesota Donor Lung Quality Index (UMN-DLQI), we used expert opinion to create an online survey that ranked 17 lung donor and recipient factors and graded their importance on a scale of 0 to 10. To arrive at consensus-based weights for each of the 17 factors, we used magnitude estimation (ME) methods. We performed receiver operating characteristic (ROC) analyses to evaluate predictive value. An application (app) was developed to simplify the scoring process. A second review process was instituted for every donor offer with an UMN-DLQI score greater than 40 as of September 2014 (post–donor score era). Results Worldwide, 11 transplantation centers (including ours) completed our survey. Results showed strong consensus among transplantation physicians across disparate practices. UMN-DLQI scores greater than 40 provided a sensitivity of 89%, a specificity of 55%, and a positive predictive value of 52% for donor offer acceptance. Number of transplants (63 versus 48) and donor lung use (15.1% versus 8.9%; p = 0.02) were significantly better in the post–donor score era without a penalty in transplantation outcomes. There was a trend toward a lower incidence of any primary graft dysfunction within 72 hours (40% versus 75%; p = 0.06) with a UMN-DLQI greater than 40 but no difference in 30-day or 1-year survival. Conclusions The UMN-DLQI scoring app is a simple tool for describing the attributes of a donor lung offer. More attention to scores greater than 40 safely improved donor lung use at a single institution.

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