De Soyza AG, Corris PA. 2001. Donor-Recipient compatibility [online]. Freeman Hospital, Newcastle Upon Tyne, UK. Available from http://www.cysticfibrosismedicine.com

Tissue typing

Unlike renal transplantation, formal tissue typing is not performed for pulmonary transplantation. Retrospective studies have shown that HLA matched organs do have lower rates of chronic rejection. The potential benefit of tissue typing are, however, small and would result in unacceptable increases in graft ischaemic time.

Blood group

The main matching criteria for lung and heart/lung transplantation is blood group compatibility.

Cytomegalovirus status

To avoid primary cytomegalovirus infection, the donor and recipient should be matched when possible for previous CMV exposure

.

These selection criteria have been challenged as too didactic and the concept of "marginal donor" that does not fufil all the above criteria has been proposed. Evidence suggests the long term outcomes of using such donors does not differ significantly from those of an ideal donor. The current uptake of organs form offered donors is low and a small increase in the acceptance rates may markedly increase the number of transplants performed. Work from Australia, where a physician and a surgeon assess and actively manage a donor, has shown that this approach increases the uptake of offered organs.

Donor organ evaluation may now reach a more combined clinical-scientific phase after early reports of increased rates of early graft dysfunction in patients who received donor organs that had subclinical graft inflammation (as determined by donor bronchoalveolar lavage levels of Interleukin 8)

Bibliography

Fisher AJ, Dark JH, Corris PA. Improving donor lung evaluation: a new approach to increase organ supply for lung transplantation. Thorax 1998; 53(10):818-20.

Fisher AJ, Donnelly SC, Hirani N, Burdick MD, Strieter RM, Dark JH, Corris PA. Enhanced pulmonary inflammation in organ donors following fatal non-traumatic brain injury. Lancet 1999; 353(9162):1412-3.

Frost AE. Donor criteria and evaluation. Clinics in Chest Medicine 1997; 18(2):231-7.

Gabbay E, Williams TJ, Griffiths AP, Macfarlane LM, Kotsimbos TC, Esmore DS, Snell GI. Maximizing the utilization of donor organs offered for lung transplantation. American Journal of Respiratory & Critical Care Medicine 1999; 160(1):265-71.

Snell GI, Griffiths A, Macfarlane L, Gabbay E, Shiraishi T, Esmore DS, Williams TJ. Maximizing thoracic organ transplant opportunities: the importance of efficient coordination. Journal of Heart & Lung Transplantation 2000; 19(4):401-7.

Stewart S, Ciulli F, Wells FC, Wallwork J. Pathology of unused donor lungs. Transplantation Proceedings 1993; 25(1 Pt 2):1167-8.

Sundaresan S, Semenkovich J, Ochoa L, Richardson G, Trulock EP, Cooper JD, Patterson GA. Successful outcome of lung transplantation is not compromised by the use of marginal donor lungs. Journal of Thoracic & Cardiovascular Surgery 1995; 109(6):1075-9; discussion 1079-80.