A three-tier system for evaluation of organ procurement organizations' willingness to pursue and utilize nonideal donor lungs

Lungs from nonideal, but acceptable donors are underutilized; however, organ procurement organization (OPO) metrics do not reflect the extent to which OPO-specific practices contribute to these trends. We developed a comprehensive system to evaluate nonideal lung donor avoidance, or risk aversion among OPOs. Adult donors in the UNOS registry who donated >= 1 organ for transplantation between 2007 and 2018 were included. Nonideal donors had any of age>50, smoking history >= 20 pack-years, PaO2/FiO(2) ratio <= 350, donation after circulatory death, or increased risk status. OPO-level risk aversion in donor pursuit, consent attainment, lung recovery, and transplantation was assessed. Among 83916 donors, 70372 (83.9%) were nonideal. Unadjusted OPO-level rates of nonideal donor pursuit ranged from 81 to 100%. In a three-tier system of overall risk aversion, tier 3 OPOs (least risk-averse) had the highest rates of nonideal donor pursuit, consent attainment, lung recovery, and transplantation. Tier 1 OPOs (most risk-averse) had the lowest rates of donor pursuit, consent attainment, and lung recovery, but higher rates of transplantation compared to tier 2 OPOs (moderately risk-averse). Risk aversion varies among OPOs and across the donation process. OPO evaluations should reflect early donation process stages to best differentiate over- and underperforming OPOs and encourage optimal OPO-specific performance.

Automated summary

The study found that nonideal but acceptable lung donors are underutilized, and differences in practices among organ procurement organizations (OPOs) also contribute to this trend. Risk aversion varies among different OPOs and impacts donor pursuit, consent attainment, lung recovery, and transplantation.