The number of patients awaiting lung transplantation (LT) and waiting time
for surgery is increasing. In Australia, LT rates are 4.6/million populatio
n/yr, which despite low organ donation rates, are the highest published in
the world. The Australian organ allocation system allows identification of
marginal donors and therapeutic manipulation where appropriate. This study
aims to assess the impact of utilization of marginal donors and aggressive
donor management. A comparison between published donor criteria and local p
ractice is made, allowing assessment of the effect of using marginal donors
on outcome. Donor management included antibiotic therapy, strict fluid man
agement, physiotherapy, bronchoscopy and bronchial toilet, and alteration o
f ventilatory settings including initiation of pressure support. Blood gase
s were repeated to assess the results of interventions. Between January 1,
1995 and May 31, 1998, we performed 140 transplants from 112 of 219 (51%) l
ung donor offers. Of these donors, 48 (43%) satisfied all published criteri
a for suitable donor organs (Croup 1 = ideal donors) and 64 (57%) did not (
Group 2 = marginal donors). Criteria breached by the marginal donors were:
an initial ratio of arterial oxygen pressure to fraction of inspired oxygen
(Pa-O2/FIO2) < 300 mm Hg (n = 20), abnormal radiology (n = 39), pulmonary
infection (n = 24), 20 pack-years smoking (n = 5) and age > 55 yr (n = 4).
Therapeutic manipulation resulted in improvement in the Pa-O2/FIO2 ratio in
20 donors (Group 3) who would not otherwise have been used. Immediate and
24 h postoperative gas exchange and length of intensive care unit (ICU) sta
y was not different for recipients from donors from all three groups. Overa
ll survival was 94% at 30 d, 83% at 1 yr, 70% at 2 yr, and 62% at 3 yr and
was not significantly different from the three groups. We conclude that org
an utilization can be maximized by therapeutic manipulation and utilization
of marginal donors without compromising results from transplantation.