A retrospective review of declined lung donors: estimating the potential of ex-vivo lung perfusion.

Abstract Background Even in the extended-criteria era, the reasons for declining lung donors are not always clear. Furthermore, it has not been determined how many actual declined lungs would be retrieved by ex-vivo lung perfusion (EVLP) beyond that already achieved in centers with an existing high utilization rate. Methods This retrospective study reviewed all lung donor referrals between 2014-2018, including detailed formal referrals and preliminary notifications. This study categorized reasons for lung donor non-acceptance and estimated how many declined grafts could have been theoretically retrievable by using EVLP. Results In total, 966 lung donor candidates were referred, including 313 transplanted donors, 336 declined donors after detailed referrals (Group A) and 258 preliminary declined. In the Group A, the primary reasons for refusal were lung quality issues (49%), general medical issues (25%), and organization issues (26%), combined with secondary reasons in many cases. Main lung quality issues were an extensive smoking history, abnormal chest radiography and underlying lung disease. Although 73 declined lung donors had indications for EVLP, the retrievable lungs decreased to only 30 cases after considering the details of all clinical contraindications and organizational issues. However, 59 intended donation after circulatory death donors did not progress to death after withdrawal of cardiorespiratory support in the required timeframe, and EVLP may have an emerging additional role here. Conclusions Based on commonly cited criteria for EVLP indication, the number of EVLP retrievable lung donors represented only a small portion of declined donor lungs referred to our center from the state donation network.