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Peer-reviewedCC BYThe Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation

Impact of donor care unit opening and use on lung donation from deceased organ donors after brain death

  • Felicia Y. Ho1
  • Xingmei Wang2
  • Douglas E. Schaubel3
  • Mauer Biscotti4
  • Meeta Prasad Kerlin5
  • Peter P. Reese6
  • Jason D. Christie5
  • Emily A. Vail7,8
8 affiliations
  1. 1University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, US
  2. 2University of Pennsylvania Biostatistics Analysis Center, Philadelphia, PA, US
  3. 3University of Pennsylvania Department of Biostatistics, Epidemiology, and Informatics, Philadelphia, PA, US.
  4. 4University of Pennsylvania Department of Surgery, Division of Cardiac Surgery, Philadelphia, PA, US
  5. 5University of Pennsylvania Department of Medicine, Division of Pulmonary, Critical Care and Allergy, Philadelphia, PA, US
  6. 6Vanderbilt Center for Transplant Science, Nashville, TN, US
  7. 7University of Pennsylvania Department of Anesthesiology and Critical Care, Philadelphia, PA, US
  8. 8Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, US
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Abstract

BACKGROUND: Deceased donors after brain death (DBD) transferred to donor care units (DCUs) have higher rates of lung donation than donors remaining in hospitals, but contributions of regional DCU availability and donor transfer to lung donation remain unknown. MATERIALS AND METHODS: Cohort study using Organ Procurement & Transplantation Network (OPTN) deceased donor registry files, including adult DBDs managed in donation regions with operating DCUs, 2017-2024. Multivariable logistic regression and G-computation were used to test the hypothesis that individual donor transfer to DCU, rather than regional DCU availability, is associated with a higher likelihood of lung donation (primary outcome). RESULTS: Among 27,795 DBDs managed by 28 OPOs, lung donation rate was 28.6% (7,958 donations). After adjustment for donor characteristics, predicted lung donation rates were similar before (29.1%, 95% CI 27.9-30.2) and after (28.9%, 95% CI 28.3-29.6) regional DCU adoption. Despite wide variation in regional transfer rates (5.2-96.7%), greater regional transfer was not associated with lung donation. After adjustment for donor factors, organ recovery year, and organ procurement organization, donor transfer to DCUs (vs. hospitals) remained associated with higher odds of lung donation overall (aOR 1.32, 95% CI 1.20-1.46) and for each DCU type (independent (aOR 1.41, 95% CI 1.21-1.65) and hospital-based (aOR 1.27, 95% CI 1.12-1.44)). CONCLUSIONS: Superior lung donation rates were seen only for donors transferred from regional hospitals to DCUs. There was no observable association between the proportion of donors transferred and lung donation, suggesting that superior donation outcomes may reflect the selection of donors for transfer rather than system-wide effects of DCU availability.

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Cite

BibTeXRIS
BibTeX
@article{ho2026impact,
  title = {{Impact of donor care unit opening and use on lung donation from deceased organ donors after brain death}},
  author = {Felicia Y. Ho and Xingmei Wang and Douglas E. Schaubel and Mauer Biscotti and Meeta Prasad Kerlin and Peter P. Reese and Jason D. Christie and Emily A. Vail},
  journal = {The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation},
  year = {2026},
  month = oct,
  doi = {10.1016/j.healun.2026.10.022},
  url = {https://doi.org/10.1016/j.healun.2026.10.022},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Impact of donor care unit opening and use on lung donation from deceased organ donors after brain death
AU  - Felicia Y. Ho
AU  - Xingmei Wang
AU  - Douglas E. Schaubel
AU  - Mauer Biscotti
AU  - Meeta Prasad Kerlin
AU  - Peter P. Reese
AU  - Jason D. Christie
AU  - Emily A. Vail
PY  - 2026
DA  - 2026/10/22
JO  - The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation
DO  - 10.1016/j.healun.2026.10.022
UR  - https://doi.org/10.1016/j.healun.2026.10.022
AB  - BACKGROUND: Deceased donors after brain death (DBD) transferred to donor care units (DCUs) have higher rates of lung donation than donors remaining in hospitals, but contributions of regional DCU availability and donor transfer to lung donation remain unknown. MATERIALS AND METHODS: Cohort study using Organ Procurement & Transplantation Network (OPTN) deceased donor registry files, including adult DBDs managed in donation regions with operating DCUs, 2017-2024. Multivariable logistic regression and G-computation were used to test the hypothesis that individual donor transfer to DCU, rather than regional DCU availability, is associated with a higher likelihood of lung donation (primary outcome). RESULTS: Among 27,795 DBDs managed by 28 OPOs, lung donation rate was 28.6% (7,958 donations). After adjustment for donor characteristics, predicted lung donation rates were similar before (29.1%, 95% CI 27.9-30.2) and after (28.9%, 95% CI 28.3-29.6) regional DCU adoption. Despite wide variation in regional transfer rates (5.2-96.7%), greater regional transfer was not associated with lung donation. After adjustment for donor factors, organ recovery year, and organ procurement organization, donor transfer to DCUs (vs. hospitals) remained associated with higher odds of lung donation overall (aOR 1.32, 95% CI 1.20-1.46) and for each DCU type (independent (aOR 1.41, 95% CI 1.21-1.65) and hospital-based (aOR 1.27, 95% CI 1.12-1.44)). CONCLUSIONS: Superior lung donation rates were seen only for donors transferred from regional hospitals to DCUs. There was no observable association between the proportion of donors transferred and lung donation, suggesting that superior donation outcomes may reflect the selection of donors for transfer rather than system-wide effects of DCU availability.
SN  - 1053-2498
SN  - 1557-3117
ER  -