Donation After Brain Death Versus Donation After Circulatory Death Donors in Lung Transplantation: Are They Different?

Abstract

Historically, lung transplantation has been restricted by the number of suitable quality donor lungs. However, following a careful extension of clinical practice, the size of the donor pool of available lungs has increased dramatically in the last decade. Donation after brain death (DBD) and donation after circulatory death (DCD) lungs, both ideal and extended criteria, are now commonly utilised for transplantation in Australia. Indeed, of the 196 lung transplants performed in Australia in 2016 (one of the highest per-million population rate in the world) 22% were DCD. There are important differences in the legal and consent processes, Intensive Care Unit management strategies, lung pathophysiology, logistics and potential-to-actual donor conversion rates between DBD and DCD. Notwithstanding, the long term outcomes of lung transplantation from both DBD and DCD donation pathways are now essentially identical. A recent Australian audit suggested there remains a large untapped pool of DCD (but not DBD) lungs that may yet further dramatically increase lung transplant numbers. The insights gained from the last decade of DCD lung transplantation provides strategies, knowledge and techniques to enable even greater transplant numbers and enhanced quality of both DCD and even DBD donor lungs as we move into a second decade of DCD lung transplantation in Australia.