Objective assessment of criteria for selection of donor lungs suitable for transplantation

Background: Donor organ shortage severely limits lung transplantation as a therapeutic option, yet many potential donor lungs are deemed unsuitable by clinical selection criteria. Methods: Of 39 consecutive potential donor lungs, 14 were accepted and 25 excluded by clinical selection criteria. All were evaluated prospectively by clinical assessment, bronchoscopy, and bronchoalveolar lavage (BAL) to evaluate objectively the discrimination of pulmonary infection and injury. Results: Accepted donors were significantly younger than those excluded ( mean (SD) age 36.7 (15.3) years v 49.5 (13.2) years; p = 0.009, unpaired t test) and were more likely to have suffered traumatic brain death (50% v 20%; p = 0.07, Fisher's exact test). Oxygenation (PaO2: FiO(2)) was higher in accepted donors than in excluded donors (median (range) 63.2 (48 - 82.5) kPa v 43.1 (7.7 - 71.7) kPa; p = 0.0001, Mann-Whitney test). Positive formal BAL culture was more frequent in accepted donors (75%) than in those excluded (43%; p = 0.1, Fisher's exact test). There was no significant difference in the percentage and concentration of neutrophils in BAL fluid between accepted and excluded donors ( median (range) 37.9 (0 - 96.9)% and 44.6 (0 - 1190) x 10(3)/ ml v 36 (1 - 98.1)% and 46 (0.2 - 1457) x10(3)/ml), nor in the BAL fluid concentration of tumour necrosis factor-alpha (140 (0 - 340) pg/ml v 160 (0 - 760) pg/ml) or interleukin 8 (810 (33 - 17 600) pg/ml v 540 (0 - 15 110) pg/ml). Conclusion: Current selection criteria are poor discriminators of pulmonary injury and infection and lead to the exclusion of potentially usable donor lungs.