Lung Utilization and Transplant Outcomes after Donor Management at an In-Hospital Donor Care Unit versus the Donor Hospital.

BACKGROUND: Fewer than 20% of donated lungs are transplanted. We examined the impacts of donor management and recovery at an in-hospital donor care unit (DCU) established in 2021 versus the donor hospital (DH). METHODS: Using Organ Procurement & Transplantation Network data on donors recovered March 2021 to December 2024, we compared lung utilization and post-transplant outcomes after donor management in the DCU (n=334) versus the donor hospital (DH, n=399), adjusting for donor factors with propensity weighting. Secondary outcomes included heart, liver, and kidney utilization. Changes in donor PaO2/FiO2 (P/F ratio) were examined as a hypothesized effect modifier. We projected the national impact of improved utilization on lung transplant volume. RESULTS: After adjusting for donor differences, lung utilization was 88% higher (aRR: 1.88; 95% CI: 1.40, 2.53) in the DCU versus DH setting. Median P/F ratio increased from 275 to 348 mmHg (p<0.0001) in the DCU and explained approximately 38% of the improvement in lung utilization. Non-lung organ utilization was either improved or non-inferior in the DCU. Lung graft survival and pulmonary function were similar for recipients of DCU versus DH-managed donors. Nationally, an 88% improvement in lung utilization among donors not currently transferred to a DCU could theoretically result in ≥300 more lung transplants per year. CONCLUSIONS: Lung transplantation can be nearly doubled through lung-centric donor management in a DCU, without sacrificing recipient outcomes nor the utilization of other organs. Donor management practices to optimize lung utilization should be proliferated by establishing more DCUs and, where feasible, applying lung-centric protocols in donor hospitals.