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Impact of Donor Care Unit Models on Lung Transplant Outcomes

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In a bid to alleviate the critical shortage of organs for transplantation, the efficiency of donor care units (DCUs) becomes paramount. This study scrutinizes the effectiveness of two prevalent DCU models—independent and hospital-based—in managing deceased organ donors and their subsequent lung transplant outcomes. The examination of these models could potentially guide future improvements in the field of organ donation and transplantation.

Study Design and Participants

This retrospective cohort study delves into data from the Organ Procurement and Transplantation Network’s deceased donor registry, focusing on lung transplant recipients from 21 US donor service areas that operate DCUs. The study encompasses deceased organ donors aged 16 and older, who underwent organ recovery from April 26, 2017, to June 30, 2022, as well as the patients who received lung transplants from these donors. Data analysis was conducted between May 2023 and March 2024, with the primary exposure being the type of DCU—independent versus hospital-based.

Outcomes and Measures

The main outcome assessed was the survival duration of transplanted lungs through December 31, 2023. A Cox proportional hazards model, adjusted for donor and recipient characteristics, was employed to compare graft survival between the two DCU types. The findings reveal that unadjusted lung donation rates were generally higher in DCUs than local hospitals, but with notable differences between hospital-based and independent DCUs.

Among the 10,856 donors included in the study, 5,149 underwent recovery procedures in DCUs—1,466 in hospital-based DCUs and 3,683 in independent DCUs. It was observed that the lungs from independent DCUs had a shorter mean survival time compared to those from hospital-based DCUs. Specifically, the restricted mean survival time was 1548 days in independent DCUs versus 1665 days in hospital-based DCUs, and this difference was statistically significant.

Key Inferences

– Lung donations were more frequent in independent DCUs compared to hospital-based ones.
– Despite higher donation rates, lungs from independent DCUs exhibited shorter survival times than those from hospital-based DCUs.
– Further research is needed to identify the factors contributing to the disparity in survival times between the two DCU models, such as donor management practices and lung evaluation protocols.

The study concludes that while independent DCUs facilitate higher lung donation rates, the longevity of transplanted lungs is superior when recovered from hospital-based DCUs. This underscores the necessity for ongoing research to pinpoint the factors influencing these outcomes, aiming to refine the organ donation and transplantation process.

Original Article: JAMA Netw Open. 2024 Jun 3;7(6):e2417107. doi: 10.1001/jamanetworkopen.2024.17107.

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