Recommendations for the Use of Extended Criteria Donors in Lung Transplantation P.M. Pêgo-Fernandes, M.N. Samano, A.I. Fiorelli, L.M. Fernandes, S.M. Camargo, A.M. Xavier, P.A. Sarmento, W. M. Bernardo, M.C. Ribeiro de Castro, and F.B. Jatene ABSTRACT Selection criteria for lung donation were based on initial experiences with lung transplan- tation without further studies to improve them, thereby guaranting the best use of donated organs. A definition of an extended criteria donor is therefore required to obtain more lungs to meet the demands of patients awaiting transplantation. Studies have been reviewed for the impact on survival and morbidity of age ranges, oxygen fraction, cause of death, smoking habits, x-ray findings, infection, hepatitis serology and non– heart-beating status, seeking to support physicians to make decisions regarding the use of marginal organs. D EFINING extended donor criteria for lung transplan- tation requires first of all a definition of the criteria for an optimal lung donor. With minor differences these criteria are practically the same in transplantation centers throughout the world. They are still based on early experi- ences with lung transplantation and have not been sup- ported by more consistent studies. 1 The low utilization rate of donated lungs makes this transplantation among the least performed modalities. This limitation is due to the deterioration of this organ after brain death, to contact with environmental air by means of mechanical ventilation, and to its prompt congestive re- sponse to volume resuscitation, becoming inadequate for use. Increasing the number of transplantations using nonop- timal donors becomes an option due to a lack of donors. In this context, the Brazilian Association of Organ Transplan- tation (ABTO) has developed this project to establish guidelines for the use of extended criteria donors in pul- monary transplantation. 2 A marginal donor may be defined as one who does not present these optimal conditions, (Table 1). The recommendations herein were aimed to support physicians and other professionals to make decisions re- garding the use of extended criteria lung donors as well as the complications, ethical issues, and expected results therewith. These recommendations were not aimed to establish indications or contraindications for the use of marginal donors, but to support the medical practice by providing general guidelines of conduct, which must be analyzed with reference to the individual characteristics of each potential donor. METHODS To develop recommendations for the use of extended criteria donors, we reviewed the relevant literature, selecting studies with the best levels of evidence to work as a basis for organ use criteria. Recommendation Grade and Level of Evidence ● A: More consistent experimental or observational studies. ● B: Less consistent experimental or observational studies. ● C: Case reports (uncontrolled studies). ● D: Opinion without clinical assessment, based on consensus, physiologic studies, or animal models. RESULTS Impact of the Use of Extended Criteria Donors on the Survival and Morbidity of Transplant Patients The use of extended criteria donors does not increase immediate or long-term postoperative death rates. 3,4 How- ever, evidence suggests greater 30-day mortality rates with the use of these donors. 6 As to morbidity, the use of From the Department of Cardiopneumonology (P.M.P.-F.), the Heart Institute (M.N.S., A.I.F., L.M.F.), Hospital das Clinicas, Medical School, University of São Paulo; the Thoracic Surgery Service, São Paulo Federal University (S.M.C., A.M.X., P.A.S.); Brazilian Association of Organ Transplantation (M.C.R.C.); the Thoracic Surgery Discipline (F.B.J.), Medical School, University of São Paulo; and the Brazilian Medical Association (W.M.B.), São Paulo, Brazil. Address reprint requests to Paulo Manuel Pêgo-Fernandes, Rua Enéas de Carvalho Aguiar, 44 – Bloco II, 2° andar, sala 9, São Paulo/SP – CEP 05403-000 Brazil. E-mail: paulopego@ incor.usp.br 0041-1345/11/$–see front matter © 2011 Published by Elsevier Inc. doi:10.1016/j.transproceed.2010.12.050 360 Park Avenue South, New York, NY 10010-1710 216 Transplantation Proceedings, 43, 216 –219 (2011)