Eligibility and Availability of Lungs for Transplantation: The French Experience

Purpose The shortage of available donor lungs limits lung transplantation. In 2003, French transplant community set up a new definition of eligibility of lungs for transplantation ( Table ). In 2011, l’Agence de la biomedicine in collaboration with the transplant teams decided to extensively offer the lungs from extended criteria donors in order to improve utilization of potential lung donors. We report here the effect of this new policy on the number of multiorgan donors in whom lungs were offered and harvested as well as on patient survival. Methods and Materials All brain dead donors (BDDr) from which at least 1 organ was retrieved in France between 2007 and 2011 were included. Descriptive analyses were performed with regard to lung proposal, lung non acceptance and lung procurement number. These descriptions were detailed according to donor category. The main causes for lung non-proposal and lung refusal were also collected. One-year graft survival was studied using Kaplan-Meier estimates. Results In 2011 as compared to 2007 the number of BDDr whose lungs were proposed increased by 58%. This rise was exclusively due to a proposal increase in the ECD group. In the same time, the refusal rate increased slightly (74% in 2007 to 86% in 2011). Eventually the number of lung procured from ECD rose from 195 in 2007 to 297 in 2011, a 52% enhance over the period. One year survival rate was similar for specific donor types: 76% [68.5%-81.2%] for OD and 77% [72.8%-79.8%] for ECD; but was not measurable for CI donor due to small size. Conclusions This study demonstrates that an extensive lung offer policy may be associated with an enhanced use of potential donors with similar post transplantation survival. Optimal Donor (OD) Extended Criteria Donors (ECD) Marginal Donors (MD) * Age + 56 ≤ Age ≤ 70 years + Age > 70 years * PaO2 > 400 mm Hg + 200 ≤ PaO2 ≤ 400 mm Hg + PaO2 * Normal chest Xray + Abnormal chest Xray * No inhalation + Inhalation * Non smoker * : And + : Or