Multi-Center Validation of a Consensus-Based Scoring Guide for Evaluating Donor Lung Offers

• Published in: The Journal of heart and lung transplantation Vol. 39; no. 4; p. S216
• Main Authors: Kennedy, C.C., Budev, M., Wille, K., Lease, E.D., Chandrashekaran, S., Levine, D.J., Nunley, D., Chan, K.M., Wilson, M., Hayanga, J., Shigemura, N., Kumar, A., Girgis, R., Sharma, N., Lyu, D., Sehgal, S., Mattar, A., Loor, G., A. On Behalf of the Donor Quality Working Group
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2020
• ISSN: 1053-2498; 1557-3117
• DOI: 10.1016/j.healun.2020.01.844

The previously described University of MN Donor Lung Quality Index (UMN-DLQI) score is a consensus-based decision tool that includes 16 risk-related components receiving 0-5 points, with higher scores signifying lower risk. A score >39 is considered favorable for transplant. We evaluated the UMN-DLQI score's performance across a diversity of US lung transplant centers. We modified the UMN-DLQI to include standardized response choices for all parameters to enhance inter rater consistency. A co investigator at each site was trained in UMN-DLQI scoring, including hypothetical donor test cases to ensure proficiency. We included consecutive primary donor offers (age >11) to participating sites between May 1 and October 31, 2016 that were either accepted for transplant or turned down for quality by the participating center. UMN-DLQI scores were calculated after donor acceptance decisions. We excluded donations after circulatory death and turn downs exclusively for size, HLA, known malignancy, unmet multi-organ or laterality needs, other recipient or donor issues, or excess travel time. We explored associations between the UMN-DLQI score with discrepant donor decisions (organs turned down that were subsequently transplanted elsewhere) and recipient outcomes. Eleven centers participated. 183 donor organs were accepted and transplanted. Accepted donors averaged 35 years old and 16% met increased risk criteria. The median UMN-DLQI score was 43 (range 32 - 50). One in five transplanted organs scored <40 (22%). Few accepted donors were heavy smokers (8%), had risk of lung (1%) or other malignancy (5%), or had anticipated surgical complexity (5%). Few accepted offers lost points for low oxygenation (5 %), with a mean PaO2 to FiO2 (P/f) ratio of 424. Likewise, few lost points for risks of pre-existing lung disease (9 %), contusion (16 %), or positive cross match (4 %). However, 38, 24, and 28 % lost points for risk of pulmonary edema, risk of aspiration, and donor age, respectively. Additionally, the majority of accepted donors lost points for an estimated ischemic time >6 hours, donor size mismatch, or pneumonia risk (57, 53, and 61%, respectively). The mean LAS was 45.5. Multi center use of a standardized scoring instrument offers insight into donor acceptance practices and may be useful in understanding discrepant organ decisions in lung transplantation.