Promote Efficiency of Lung Donor Testing

At a glance

Current policy

In March 2023, lung allocation policy changed to follow a new framework called continuous distribution. Since continuous distribution was implemented, lung transplant programs are receiving more offers for donor lungs. The Lung Transplantation Committee has heard that programs often do not have complete or up-to-date information on lung donors when evaluating offers. The Committee proposes changes to the required testing for lung donors. The Committee also proposes updates to Guidance on Requested Deceased Lung Donor Information.

Supporting media

Presentation

View presentation

Proposed changes

Addition of more specific requirements for obtaining arterial blood gases
Require reporting of
- chest computed tomography (CT) scan, if performed
- an echocardiogram or a right heart catheterization
- chest x-ray images or interpretation of chest x-ray
Require chest x-rays to be updated every 24 hours
Remove requirement for description of sputum for a sputum gram stain

Guidance changes

Change “mycology sputum smear” to “fungal culture results”
Add “bacterial culture results”
Recommend providing a chest CT within 72 hours prior to initial offer
Suggest providing chest CT images that show the lungs
Specify that chest x-ray images are preferred over interpretations
If an echocardiogram has been done and there are still questions or concerns, recommend obtaining a right heart catheterization.

Anticipated impact

What it's expected to do
- Provide transplant programs with more information on donors
- Help transplant programs review and make decisions on lung offers faster
- Allow some flexibility for OPOs by updating guidance

What it won't do
- Will not require transplant programs to enter more data
- Will not change how lung candidates are prioritized for offers

Terms to know

Arterial Blood Gas: An arterial blood gas (ABG) test measures the oxygen and carbon dioxide levels in your blood as well as the acidity. This information shows how well your lungs move oxygen from the air into your blood when you breath in, and how well they remove carbon dioxide from your blood when you breathe out.
Echocardiogram: A test that uses sound waves to produce live images of the heart to monitor how the heart and its valves are functioning.
Organ Procurement Organization: An organization designated by the Centers for Medicare and Medicaid Services (CMS) and responsible for the procurement of organs for transplantation and the promotion of organ donation. OPOs serve as the vital link between the donor and recipient and are responsible for the identification of donors, and the retrieval, preservation and transportation of organs for transplantation. They are also involved in data follow-up regarding deceased organ donors.
Right Heart Catheterization: An invasive test that measures blood pressure and oxygen in the lungs and the right side of the heart and can show how well the heart is pumping.