Perspectives of an uncontrolled donation after circulatory death lung transplantation program

An uncontrolled donation after circulatory death (uDCD) donors program is active only in few lung transplantation (LT) centres. Our uDCD procurement protocol consists of a normothermic preservation by open-lung ventilation, followed by an ex-vivo lung perfusion (EVLP) assessment. We report our experience, highlighting the challenges of this process. From 11/2014 to 02/2023, 49 potential uDCD donors were referred to our centre from 13 different hospitals within a 300 km distance from ours. The program was inactive from 2015 to 2017 due logistical problems; conversely, it remained open during the COVID-19 pandemic, with obvious setbacks. In 23 cases, our team evaluated the organs on site; lungs were recovered from 19 donors in 8 hospitals (maximum distance 103 km). After EVLP, we performed 9 bilateral LTs: one recipient died 24 days after surgery due to early humoral rejection; the others are alive and well (mean follow-up= 1119 days, SD 963), despite the prolonged preservation ischemia times. In spite of the challenges of this type of donation, our protocol allowed us to easily implement our uDCD program even in secondary-level hospitals. Moreover, we observed an increasing number of referrals and an improved management of the logistical issues, even though we are still far from a large-scale implementation. Lastly, we confirmed the possibility of preserving lungs for longs periods of time through ventilation only.