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

Academic Article

Abstract

  • PURPOSE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.
  • Authors

    Digital Object Identifier (doi)

    Author List

  • Kennedy CC; Budev M; Wille K; Lease ED; Chandrashekaran S; Levine DJ; Nunley D; Chan KM; Wilson M; Hayanga J
  • Start Page

  • S216
  • Volume

  • 39
  • Issue

  • 4