Why Donor Lung Optimization Matters

Nearly 3.4 million annual deaths occur globally from COPD and Interstitial Lung Disease. An estimated 10,300 patients are on the global lung transplant waitlist.1

Organ Supply Challenges

The wait time for some U.S. lung transplant recipients is more than 1 year2

18% of U.S. patients in need of a lung transplant die on the waiting list. This number goes up to 20% in the E.U.2,3

Approximately 3,100 patients are added to the U.S. transplant list annually4

Only 20% of donor lungs are accepted due to quality, logistics, and capacity5

Logistics and Economic Challenges

Time & Geographical Constraints

4- to 6-hours cold ischemic time creates logistical challenges6

Clinical Uncertainty

Uncertainty in DCD lung recipient outcomes can restrict transplantation volumes7

Rising Cost

Procurement costs, waitlist times, and high-acuity cases can cause high economic burdens8

Empty hospital bed in a clinical setting

Only ~2.5% of potential DCD lungs are used

An increase in donor lungs means saving more patients who would otherwise die waiting for an organ, and more of the 3.4 million who are removed from or never make it onto the transplant waitlist.9,10

EVLP using the Toronto Technique is associated with increases in the number of lung transplants by preferentially increasing the number of DCD and extended-criteria organs.8

EVLP enables the assessment of marginal lungs11

Centres using EVLP have shown 65%–70% utilization rate of marginal donor lungs10

Associated increases in lung transplant volume and reduced waitlist mortality can result in substantial savings in the cost of transplant care8

Gives hospitals more time to organize logistics and more information for better clinical decision-making12

EVLP with the Toronto Technique:

EVLP with the Toronto Technique enables organ assessment for increased utilization of donor lungs.

At Toronto General Hospital, this has meant an increase in the overall number of lung transplants, less time on the waiting list for lung recipients, and lower mortality rates.

Photo of Dr. Shaf Keshavjee, featured in a quote about EVLP and lung transplantation

“EVLP has doubled the number of lung transplants at Toronto General Hospital, but not only that—it’s starting to do that around the world.”

Dr. Shaf Keshavjee

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  1. Safiri S, Carson-Chahhoud K, Noori M, et al. Burden of chronic obstructive pulmonary disease and its attributable risk factors in 204 countries and territories, 1990-2019: results from the Global Burden of Disease Study 2019. BMJ. 2022 Jul 27;378:e069679. doi: 10.1136/bmj-2021-069679. PMID: 35896191; PMCID: PMC9326843 ↩︎
  2. Valapour, M., Lehr, C.J., Schladt, D.P., Smith, J.M., Swanner, K., Weibel, C.J., Weiss, S. and Snyder, J.J., 2024. OPTN/SRTR 2022 annual data report: lung. American Journal of Transplantation, 24(2), pp.S394-S456. ↩︎
  3. Smits, J.M., Nossent, G.D., de Vries, E., Rahmel, A., Meiser, B., Strueber, M. and Gottlieb, J., 2011. Evaluation of the lung allocation score in highly urgent and urgent lung transplant candidates in Eurotransplant. The Journal of heart and lung transplantation, 30(1), pp.22-28. ↩︎
  4. Valapour M, Lehr CJ, Schladt DP, et al. OPTN/SRTR 2021 Annual Data Report: Lung. Am J Transplant. 2023 Feb;23(2 Suppl 1):S379-S442. doi: 10.1016/j.ajt.2023.02.009. PMID: 37132345; PMCID: PMC9970343. ↩︎
  5. Choi AY, Jawitz OK, Raman V, et al. Predictors of Older Donor Lung Use: Are We Too Good at Saying No? Ann Thorac Surg. 2020 Nov;110(5):1683-1690. doi: 10.1016/j.athoracsur.2020.04.050. Epub 2020 May 31. PMID: 32492441; PMCID: PMC7606398. ↩︎
  6. Gammie, J.S., Stukus, D.R., Pham, S.M., Hattler, B.G., McGrath, M.F., McCurry, K.R., Griffith, B.P. and Keenan, R.J., 1999. Effect of ischemic time on survival in clinical lung transplantation. The Annals of Thoracic Surgery, 68(6), pp.2015-2019. ↩︎
  7. Martens, A., Van Raemdonck, D.E., Smits, J., Verleden, S.E., Vos, R., Vanaudenaerde, B.M., Verleden, G.M., Degezelle, K., Desschans, B. and Neyrinck, A.P., 2017. A retrospective database analysis to evaluate the potential of ex vivo lung perfusion to recruit declined lung donors. Transplant International, 30(10), pp.1002-1010. ↩︎
  8. Peel, J.K., Keshavjee, S., Naimark, D., Liu, M., Del Sorbo, L., Cypel, M., Barrett, K., Pullenayegum, E.M. and Sander, B., 2023. Determining the impact of ex-vivo lung perfusion on hospital costs for lung transplantation: a retrospective cohort study. The Journal of Heart and Lung Transplantation, 42(3), pp.356-367. ↩︎
  9. Bobba, C.M., Whitson, B.A., Henn, M.C., Mokadam, N.A., Keller, B.C., Rosenheck, J. and Ganapathi, A.M., 2022. Trends in donation after circulatory death in lung transplantation in the United States: impact of era. Transplant International, 35, p.10172. ↩︎
  10. Chancellor, W.Z., Charles, E.J., Mehaffey, J.H., Hawkins, R.B., Foster, C.A., Sharma, A.K., Laubach, V.E., Kron, I.L. and Tribble, C.G., 2018. Expanding the donor lung pool: how many donation after circulatory death organs are we missing? Journal of Surgical Research, 223, pp.58-63. ↩︎
  11. Cypel, M., Yeung, J.C., Liu, M., Anraku, M., Chen, F., Karolak, W., Sato, M., Laratta, J., Azad, S., Madonik, M. and Chow, C.W., 2011. Normothermic ex vivo lung perfusion in clinical lung transplantation. New England Journal of Medicine, 364(15), pp.1431-1440. ↩︎
  12. Mallea, J.M., Johnson, D., Brown, A.W., Keller, C., Roberts, M., Sanchez, P., D’Cunha, J., Erasmus, D. and Hartwig, M.G., 2022. Extended cold preservation times are not associated with increased post-transplant mortality after ex vivo lung perfusion (EVLP) at a dedicated facility using a Centralized Lung Evaluation System (CLES). The Journal of Heart and Lung Transplantation, 41(4), p.S42. ↩︎