Lung procurement from solid organ donors: Role of fluid resuscitation in procurement failures

Purpose: To determine the incidence of and factors leading to failed lung procurement from solid organ donors at a university trauma and transplant center. Methods: Retrospective review of medical and organ procurement organization (OPO) records of all solid organ donors at a university hospital between 1992 and 1995. Student's t-test and Mann-Whitney U-test were applied for statistical analysis when appropriate. Results: 38 solid organ donors were identified over a 48 month period. A mean of 3.5 ± 0.2 solid organs were recovered per donor. 13 lungs were harvested from 9 donors for a lung procurement rate of 17.1% (p<0.01 vs procurement rates for liver [71.1%], heart [73.7%], and kidney [85.5%]). Successful lung donors were significantly younger (21 ± 4 vs. 35 ± 4 years [p<0.05]) and had a shorter time from admission to determination of brain death (20 ± 4 vs. 80 ± 20 hours [p<0.05]) than non-donors. Reasons for rejection of lungs most frequently included infection (n=8), underlying lung disease (n=5) and progressive in-hospital pulmonary dysfunction (n=9). Potential lung donors who developed progressive pulmonary dysfunction had a marked and significant positive fluid balance (7000 ± 1000 vs. 300 ± 600 cc [p<0.05]) when compared to the donor group. No patient with progressive pulmonary dysfunction had fluid and vasopressor therapy guided by the use of a pulmonary artery catheter. Conclusions: The inability to successfully procure lungs from solid organ donors remains a significant limiting factor to lung transplantation. Young patients who are quickly pronounced brain dead and proceed to organ procurement are most likely to become successful lung donors. While the reasons for failed lung procurement are multi-factorial and often unavoidable, the potential for iatrogenic injury to the lungs with over-aggressive fluid resuscitation while awaiting the determination of brain death appears significant. Clinical Implications: Potential organ donors are at significant risk for multiple complications which may lead to pulmonary deterioration and an ultimate failure of lung procurement In order to minimize the potential for pulmonary deterioration, brain death should be determined as quickly as legally possible. Prospective studies are needed to determine if the routine use of pulmonary artery catheters to guide fluid and vasopressor therapy, may lead to an increase in lung procurement rates from solid organ donors.