Rejected lungs found suitable for transplant - It may be time to reconsider the criteria.

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PROFESSIONAL ISSUES

Rejected lungs found suitable for transplant

It may be time to reconsider the criteria.

By Andis Robeznieks, AMNews staff. Oct. 21, 2002. Additional information

New research indicates that many lungs rejected for transplant may actually be suitable for use and that up to 1,000 lives each year could be saved by "liberalizing" transplant criteria.

More than 85% of donor lungs are rejected for transplant, but a new study published in The Lancet provides evidence that many of these organs could have been used.

Researchers found that 41% of 29 pairs of donated lungs examined and rejected by the California Transplant Donor Network would have been "potentially suitable" for transplantation.

"This adds further emphasis for the need to re-evaluate transplant criteria," said senior report author Michael A. Matthay, MD, an internist from the University of California San Francisco Medical Center. "I don't think that, on the basis of one observation like ours, everybody is going to change their criteria, but I think it will have serious impact because it will push the point further that there needs to be more studies on liberalizing the criteria."

Dr. Matthay said this study complements a 1999 Australian study, in which researchers found that there was little difference in the survival rates between patients receiving so-called "ideal" lungs and those receiving "marginal" lungs.

The problem, he said, is that lung transplant criteria have arbitrarily evolved without necessarily being founded on hard evidence.

"Partly by default, surgeons and transplant physicians have gone along with the idea that, if the x-ray shows a mild abnormality, or if the patient was a little older -- say 58 to 61 -- or was a moderate smoker, that patient's lungs should not be used," Dr. Matthay said. "The criteria of the past might be too strict, so it's probably time to re-evaluate them."

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