Use of the donor lung after asphyxiation or drowning: Effect on lung transplant recipients

Background. With the relative paucity of acceptabledonors for lung transplantation, criteria for extendeddonor consideration are being explored. We sought toevaluate the suitability of donors whose cause of deathwas asphyxiation or drowning (A/D) as a potential optionto enlarge the donor pool.

Methods. We queried the United Network for OrganSharing (UNOS) Standard Transplant Analysis andResearch registry for lung transplantation from 1987 to2010 to assess associations between cause of death andrecipient survival using the Kaplan-Meier method. Toadjust for potential confounders, we used a Cox proportionalhazards model and a logistic regression model toevaluate incidence of rejection within the first year.

Results. There were 18,250 adult primary lung transplantationsperformed, with 309 A/D donors. There wasno difference in survival between groups (log-rank, p [0.52). There were no differences in demographics, lengthof stay, airway dehiscence, lung allocation score (LAS),or ischemic time in univariate analysis (all p > 0.05). TheA/D lung recipients had fewer deaths from pulmonarycauses (5.8% versus 9.5%; p [ 0.02). Proportional hazardsanalysis was significant for double lung transplantation(hazard ratio [HR], 0.85; 95% confidence interval [CI], 0.80.9), height difference (HR, 1.002; 95% CI, 1.001.003),donor age greater than 50 years (HR, 0.89; 95% CI, 0.830.96), and recipient age greater than 55 years (HR, 0.8; 95%CI, 0.760.84). A/D cause of death did not impact survivalin multivariate analysis.

Conclusions. A/D as a donor cause of death was notassociated with poor long-term survival or incidence ofrejection in the first year after transplantation. Donorcause of death by A/D, when carefully evaluated andselected, should not automatically exclude the organ fromtransplant consideration. These results provide importantjustification for potentially broadening the donor poolsafely.