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Ann Thorac Surg 2007;83:264
© 2007 The Society of Thoracic Surgeons

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Original Articles: General Thoracic

Invited commentary

Heart and Lung Transplant Program, Freeman Hospital, High Heaton, Newcastle Upon Tyne, UK NE7 7DN United Kingdom

(Email: j.h.dark{at}ncl.ac.uk).

Lung transplantation, a therapeutic success of the last 20 years, remains limited by access to donor organs. Major advances have been made in early management, and mortality rates have fallen, as reported by major centers. Another area of significant progress is in the assessment and use of so-called "marginal lungs." The literature now abounds with claims of good outcome, despite ignoring the habits and standards of a previous era. However, a critical evaluation of these reports has been difficult with no means of directly comparing one set of donors with another.

The description of a Lung Donor Score from Oto and colleagues [1] is the first worthwhile attempt to weight the various pieces of information from a donor. They took five variables and by dividing each into four levels, allowed a score of between 0 and 20. In a validation exercise, there were good correlations with markers of transplant performance, such as graft dysfunction grade and length of ventilation, at least for bilateral transplants.

Some of their scoring is subjective (ie, the description of airway secretions as "minor," "moderate," or "major" varies from observer to observer, let alone between institutions or countries). Smoking history is often difficult to obtain and impossible to truly quantify. One may also argue about the weighting; at least to this observer, "moderate" secretions do not carry the same potential for a poor outcome as a donor age of 59!

However, this is a start, and the Melbourne group should be congratulated for the hard work that has gone into this first step. As a lung transplant community, we urgently need to develop and refine the concept. There should be agreement about defining the subjective variables, and as much objective, quantifiable data as possible should be collected from a large, inevitably international, cohort of patients. Only then can the variables be weighted in a mathematically robust fashion. We look forward to a future in which we can reliably compare both audit data and prospective interventions in donor care. Less experienced groups will have a firm basis for deciding on the suitability of a donor lung rather than repeating the mistakes of a previous generation.

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1. Oto T, Levvey BJ, Whitford H, et al. Feasibility and utility of a lung donor score: correlation with early post-transplant outcomes Ann Thorac Surg 2007;83:257-264.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): John Dark Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Dark, J. Search for Related Content PubMed PubMed Citation Articles by Dark, J. Related Collections Lung - transplantation Related Article