Association Between Three Lung Donor Scores and Lung Acceptance in DBD and DCD Donors

TL;DR

This study evaluates how three lung donor scores predict lung acceptance in deceased donors, finding moderate accuracy and lower acceptance for DCD donors.

Contribution

The study adapts and evaluates three donor scores in a Swiss context, highlighting their limitations and the need for improved prediction tools.

Findings

All three scores showed acceptable to moderate discriminative ability with AUC values of 0.75 for aOto, 0.70 for aET, and 0.77 for ZDS.

DCD donors were consistently less likely to be accepted for lung transplantation compared to DBD donors.

The scores showed limitations as standalone models, suggesting the need for a novel prediction tool.

Abstract

The use of extended criteria donors (ECD) has become increasingly important in lung transplantation to address organ donor shortages. To better assess lung graft quality and optimize donor selection, several scores have been developed. This study assesses whether Swiss lung acceptance practice is associated with three validated lung donor scores — the Oto Score, Eurotransplant Score (ET), and Zurich Donor Score (ZDS) — in both DBD and DCD donors. Due to limited clinical data, certain parameters of the Oto and ET Scores were adapted (aOto and aET). Data from 1515 actual deceased donors between 01.07.2014 and 30.06.2024 were analyzed. Logistic regression and AUC-ROC analysis were used to evaluate the scores' discriminative ability. Results showed that all three scores were associated with lung acceptance, with AUC values indicating acceptable to moderate discriminative ability — 0.75 for aOto, 0.70 for aET, and 0.77 for ZDS — and DCD donors being consistently less likely to be accepted for lung transplantation compared to DBD donors. Nonetheless, all three scores showed limitations as standalone models. Developing a novel, nationally applicable Swiss prediction tool integrating current lung acceptance criteria and recipient factors could improve donor–recipient matching, support more efficient organ utilization, and potentially increase transplant activity.

The infographic shows lung acceptance probabilities in DBD and DCD donors from 2014 to 2024, based on 1515 deceased donors. It assesses donor quality using aOto, aET, and ZDS scores. Key findings highlight lower acceptance probabilities for DCD lungs, moderate score discrimination, and a need for better prediction tools. Three graphs display predicted acceptance probabilities for each scoring method, showing DBD and DCD data points.

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