Lung Donation After Circulatory Death: Current Challenges and Opportunities in the United States
摘要
Since the National Academies of Sciences, Engineering, and Medicine issued a report in 2022 calling for expansion of the supply of transplantable organs, the utilization of lungs acquired through donation after circulatory death (DCD) for transplantation has increased notably in the United States. However, despite collaborative efforts by all stakeholders in the transplant community, the outcomes of DCD lung transplantation have lagged behind the notable successes seen after transplantation of DCD abdominal organs, such as kidneys and livers. To overcome these challenges, the complexities inherent to lung biology and the greater vulnerability of lung tissue to ischemia-reperfusion injury, which make DCD lungs uniquely challenging, need to be understood in depth. The future of DCD lung transplant practices holds promise with evolving strategies potentially capable of bridging this outcome gap. In this review, the potential benefits of transplanting DCD lungs from an organ biology perspective, the evolving role of machines in organ recovery practices, and the role of normothermic regional perfusion in transforming organ recovery will be summarized in light of unique but distinct organ features inherent to lungs.