J Korean Med Sci.  2017 Dec;32(12):1953-1958. 10.3346/jkms.2017.32.12.1953.

Current Status and Future of Lung Donation in Korea

• Yeo HJ
• Yoon SH
• Lee SE
• Jeon D
• Kim YS
• Cho WH
• Kim DH

• KMID: 2396371
• DOI: http://doi.org/10.3346/jkms.2017.32.12.1953

Abstract

Lung transplantation is the only effective treatment option for patients with end-stage lung disease. However, donor organ shortage makes timely transplant not possible for all patients, especially in Korea. We investigated the number and utilization of donor lungs by retrospectively reviewing all donor organs registered in the Korea Network for Organ Sharing database from March 2012 to March 2016. The donors were stratified into 4 groups by donor acceptability criteria. A total of 1,304 donors were included. Of those, 295 brain-dead donors (22.6%) consented to lung donation. Among these consented donors, 168 donors (12.9%) were retrieved for lung transplant. Retrieval rate was very low compared with that of the kidney (93.9%), liver (86.3%), and heart (27.3%). The characteristics of utilized donor lungs were: mean age, 40.5 years (range: 18 to 63 years); mean partial pressure of oxygen, 356.5 mmHg; mean smoking history, 5.9 pack-years; and mean body mass index, 22.6 kg/m². The proportion of donors with acceptable condition of the transplanted lungs was only 39.3% (ideal 19, standard 47, marginal 70, unusable 32). Among brain-dead patients who denied to donate lungs (n = 1,009), 82 were potentially acceptable donors (ideal 19, standard 63), which was equal to half of actually transplanted lung donations. Many potential donor lungs, which are currently excluded, may be successfully used in lung transplantation in Korea. The available lung donors must be actively selected and managed to maximize the utilization of this precious resource.

Keyword

Lung Transplantation; Donor; End Stage Lung Disease; Korea

MeSH Terms

Body Mass Index
Heart
Humans
Kidney
Korea*
Liver
Lung Diseases
Lung Transplantation
Lung*
Oxygen
Partial Pressure
Retrospective Studies
Smoke
Smoking
Tissue Donors
Oxygen
Smoke

Figure

• 

  Fig. 1 Flowchart of donor lung utilization. During the study period, 1,397 brain-dead donors registered in the KONOS (≥ 18 years). A total of 1,304 donors were included except for 93 who had no PF ratio results. Of those, 295 brain-dead donors (22.6%) were consented to lung donation. Among these consented lung donors, 168 (12.9%) were finally transplanted to allocated recipients. KONOS = Korea Network for Organ Sharing, PaO2 = partial pressure of oxygen in arterial blood, FIO2 = fraction of inspired oxygen, PF ratio = PaO2/FIO2 ratio.

• 

  Fig. 2 Classification of utilized lung donors, disused lung donors and lungs that were refused to be donated according to the donor acceptability criteria. (A) Utilized donor lungs. (B) Disused donor lungs. (C) Denied lung donation. The percent of donors with acceptable condition of the transplanted lungs was only 39.3%. Among brain-dead patients who denied to donate lungs (n = 1,009), 82 were potentially acceptable donors, which was equal to half of actually transplanted lung donations.

• 

  Fig. 3 Utilization rates of donor organs. Overall, 12.9% of organ donors were accepted and retrieved for lung transplant. Retrieval rate was very low compared with the kidney (93.9%), liver (86.3%), and heart (27.3%) use.

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  Fig. 4 Lung transplantation and wait-listing rates during the study duration. During the study period, there were 298 patients on the waiting list for lung transplantation, only 56% (n = 168) received lung transplants.

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