Controlled donation after circulatory death (DCD) donors: a focus on the utilization of pediatric donors and outcomes after lung transplantation

Abstract Background Access to timely suitably size-matched quality organs remains a challenge for pediatric (pLTx) and adult (aLTx) lung transplantation. The outcomes of donation after circulatory death (DCD) donor lungs from pediatric or adult donors are rarely reported. Methods This report describes our center's controlled DCD and pLTx activity (≤age 18yrs) and outcomes since 2006 when DCD LTx started at the Alfred. Results 40 pLTx have been performed since 2006, 9 utilizing DCD and 31 donation after brain death (DBD) donors. 22 pLTX have been done since 2012 (when DCD pLTx started); 9 DCD LTx (median age 15yrs) included 4 pediatric DCD donors (mean age 8yrs), 5 adult (including 2 cutdown bilobar) DCD LTx donors (mean age 43yrs). The other 13 pLTx utilized DBD donors- 8 pediatric (mean age 9yrs), 5 adult (including 2 cutdown bilobar) DBD LTx donors (mean age 44yrs). 100% survived 1yr, and 7/9 DCD pLTx are alive (median of 1316 days), with one Chronic Lung Allograft Dysfunction (CLAD) death at 531 day and one renal failure death at 1813 days. 3 waiting list pediatric deaths occurred at 1, 66 and 320 days. Since 2006, 77 pediatric donors have been used for LTx. 15 of these were DCD donors (median age 16yrs), 11/ 15 have been used for aLTx. 10/11 aLTx are alive at a median 1992d with 1 death at day 2444 from CLAD. Conclusion Controlled DCD provide a significant and quality donor lung pool to increase LTx opportunities for pediatric patients (and adults) with terminal lung disease.