Current Status and Future of Lung Donation in Korea

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.

Extracorporeal membrane oxygenation as a bridge to lung transplantation: analysis of Korean organ transplantation registry (KOTRY) data

“…Lung transplantation has become an accepted treatment for carefully selected patients with end-stage lung disease [1,2]. However, due to a shortage of donors, the number of patients on waiting lists is growing rapidly and the average waiting time to lung transplantation has increased [3,4]. Given these circumstances, there has been a corresponding increase in demand for mechanical ventilation (MV) and extracorporeal membrane oxygenation (ECMO) support to bridge these critically ill patients to lung transplantation.…”

The First Living-Donor Lobar Lung Transplantation in Korea: a Case Report

“…Among 1,304 cases of brain death occurred between 2012 and 2016, 168 (12.9%) lung donations were actually transplanted to the recipients. 3 This usage rate is remarkably low compared with those of kidney (94%), liver (86%), and heart (27.3%) donations. Considering that the rate of acquiring lungs in Japan is 63.0%, 4 active intervention to increase the usage rate of the lungs in the event of brain death is necessary to overcome this donor-shortage issue.…”

Performance Changes Following the Revision of Organ Allocation System of Lung Transplant: Analysis of Korean Network for Organ Sharing Data

“…A marginal donor was defined as when any of the following parameters was fulfilled: age ≥ 55 years, PF ratio ≤ 300, smoking history ≥ 20 pack-years, consolidation or collapse in the chest radiograph, organisms in sputum cultures, and purulent secretion or inflammation on bronchoscopy. 8 …”