@article{e640470151f24e30835e607f6c8695ea,
title = "Improving the predictability of time to death in controlled donation after circulatory death lung donors",
abstract = "Although the use of donation after circulatory death (DCD) donors has increased lung transplant activity, 25–40% of intended DCD donors do not convert to actual donation because of no progression to asystole in the required time frame after withdrawal of cardiorespiratory support (WCRS). No studies have specifically focussed on DCD lung donor progression. This retrospective study reviewed intended DCD lung donors to make a prediction model of the likelihood of progression to death using logistic regression and classification and regression tree (CART). Between 2014 and 2018, 159 of 334 referred DCD donors were accepted, with 100 progressing to transplant, while 59 (37%) did not progress. In logistic regression, a length of ICU stay ≤ 5 days, severe infra-tentorial brain damage on imaging and use of vasopressin were related with the progression to actual donation. CART modelling of the likelihood of death within 90-minute post-WCRS provided prediction with a sensitivity of 1.00 and positive predictive value of 0.56 in the validation data set. In the nonprogressed DCD group, 26 died within 6 h post-WCRS. Referral received early after ICU admission, with nonspontaneous ventilatory mode, deep coma and severe infra-tentorial damage were relevant predictors. The CART model is useful to exclude DCD donor candidates with low probability of progression.",
keywords = "donation after circulatory death, lung transplant, organ donation, progression within time frame",
author = "Shuji Okahara and Snell, {Gregory I.} and Mark McDonald and Rohit D{\textquoteright}Costa and Helen Opdam and Pilcher, {David V.} and Bronwyn Levvey",
note = "Funding Information: The authors have declared no funding. The authors acknowledge DonateLife Victoria and The Australian Organ and Tissue Authority for providing Electronic Donor Record, and Lungitude Foundation for the general lung transplant research support. The authors and the ANZICS CORE management committee would like to thank clinicians, data collectors and researchers at the following contributing sites: Albury Wodonga Health ICU; Austin Health ICU; Ballarat Health Services ICU; Barwon Health ICU; Bendigo Health Care Group ICU; Box Hill Hospital ICU; Dandenong Hospital ICU; Frankston Hospital ICU; Monash Medical Centre ICU; Royal Melbourne Hospital ICU; St Vincent's Hospital Melbourne Ltd ICU; Sunshine Hospital ICU; The Alfred Hospital; The Northern Hospital ICU; Warringal Private Hospital ICU; Western Hospital ICU. Funding Information: The authors acknowledge DonateLife Victoria and The Australian Organ and Tissue Authority for providing Electronic Donor Record, and Lungitude Foundation for the general lung transplant research support. The authors and the ANZICS CORE management committee would like to thank clinicians, data collectors and researchers at the following contributing sites: Albury Wodonga Health ICU; Austin Health ICU; Ballarat Health Services ICU; Barwon Health ICU; Bendigo Health Care Group ICU; Box Hill Hospital ICU; Dandenong Hospital ICU; Frankston Hospital ICU; Monash Medical Centre ICU; Royal Melbourne Hospital ICU; St Vincent's Hospital Melbourne Ltd ICU; Sunshine Hospital ICU; The Alfred Hospital; The Northern Hospital ICU; Warringal Private Hospital ICU; Western Hospital ICU. Publisher Copyright: {\textcopyright} 2021 Steunstichting ESOT. Published by John Wiley & Sons Ltd",
year = "2021",
month = may,
doi = "10.1111/tri.13862",
language = "English",
volume = "34",
pages = "906--915",
journal = "Transplant International",
issn = "0934-0874",
publisher = "Wiley-Blackwell",
number = "5",
}