Donation After Circulatory Death in lung transplantation

The continuing shortage of pulmonary grafts from potential DBDs has led to a resurgence of interest in lungs from DCDs. The largest experience worldwide comes with LTx from controlled DCDs while the use of lungs from uncontrolled DCDs is currently limited to small series. No apparent differences in outcome between DBD versus cDCD-LTx have been found in the large ISHLT DCD Registry and in 2 systematic reviews and meta-analyses. Donor lungs are less vulnerable to the processes of combined warm and cold ischemia that threatens the viability of other DCD organs. New techniques for in-situ lung preservation with NRP in cDCD or alveolar recruitment in uDCD and ex situ resuscitation and assessment with EVLP have become available to select donor lungs of good quality before transplantation. There is still a large untapped pool of DCD lungs that may yet further dramatically increase LTx numbers. Several potentially modifiable barriers have been recognized that impact the use of organs from DCDs, including the absence of national ethical, professional, and legal frameworks to address both public and professional concerns. Further efforts are needed in many countries to address all these aspects of the DCD pathway if we want to increase the potential of this underutilized lung donor pool.