Liberalization of donor criteria may expand the donor pool without adverseconsequence in lung transplantation

Background: Currently the most important limitation in lung transplantation is donor availability. Although liberalization of donor criteria may aid i n expanding the donor pool, the long-term effects of the use of "marginal" or "extended" donors remains unexplored. Methods: In this study, we included all patients who underwent lung transpl antation from January 1996 to December 1999 at Loyola University Medical Ce nter. We categorized patients as either receiving lungs from an "ideal" don or or an "extended" donor. Extended donors were defined as having any 1 of the following criteria: donor age > 55 years, tobacco history > 20 pack yea rs, presence of infiltrate on chest x-ray, donor ventilator time > 5 days, or donor use of inhaled drugs (cocaine or marijuana). We then compared the 2 groups with regard to short-term (operating room [OR] complications, inte nsive care unit [ICU] complications) and long-term outcomes (1-year pulmona ry function and survival). Results: Sixty-one (54%) patients received lungs from ideal donors and 52 ( 46%) patients received lungs from extended donors as defined above. We obse rved no significant differences between the 2 groups in OR complications (c ardiopulmonary bypass, bleeding complications, life-threatening arrhythmias ) or ICU complications (pneumonia, airway dehiscence, reoperation within 30 days related to transplantation). In addition, the 2 groups had similar me dian intubation times (21 hours in the ideal donor group and 20 hours in th e extended donor group; p = n.s.), hospital length of stay (14 +/- 12 days in the ideal donor group and 12 +/- 8 days in the extended donor group; p = n.s.), and hospital survival (80% and 88% in the ideal and extended donor groups, respectively). One-year follow-up revealed similar pulmonary functi on (forced expiratory volume in 1 sec [FEV1] = 2.4 liters and 2.4 liters in the recipients of bilateral ideal and extended donors, respectively, and F EV1 = 1.9 liters and 1.5 liters in the recipients of single ideal and exten ded donors) and survival (72% and 79% in the ideal and extended donor group s, respectively; p = n.s.) between the 2 groups. Conclusions: Liberalization of donor criteria does not affect outcome in th e first year after lung transplantation. By liberalizing donor criteria, we can expand the donor pool while assessing other possible mechanisms to inc rease donor availability.