# Regional Variation in Transplant Utilization and Agonal Times among Donation after Circulatory Death Lung Donors in the United States

## TL;DR

This study examines how lung transplants using donation after circulatory death (DCD) donors vary across U.S. regions, highlighting differences in donor utilization and agonal times.

## Contribution

The study identifies regional disparities in DCD lung donor utilization and agonal times across the U.S., offering insights into geographic barriers to organ transplantation.

## Key findings

- DCD lung utilization was consistently low (up to 12.7%) across all states.
- Over 75% of DCD donors had agonal times ≤30 minutes in most states, except South Florida, eastern Pennsylvania, and Colorado/Wyoming.
- DCD transplant centers were concentrated in five U.S. states despite nationwide DCD organ utilization rates exceeding 65%.

## Abstract

Utilization of donation after circulatory death (DCD) donors in lung transplant in the United States lags when compared to other countries. We sought to evaluate geographical variation in the percentage of donation after circulatory death donors, conversion to lung transplant, agonal times, and consent for donation.

We queried the United Network for Organ Sharing database (2018–2023) to identify DCD donors and compared across organ procurement organizations (OPO). We illustrated the geographical variation in the location of transplant centers using DCDs, DCD donors used for solid organ transplant/ lung transplant, and median agonal time. Also, a special mapping was performed for the geographical difference of the refusal code utilization for declining the DCD lungs.

There were 889 DCD donors where at least one lung was used for transplant, while 13,030 (75.6%) resulted in other solid organ transplants. The utilization of DCD organs was >65% and equal across the US, while DCD transplant centers were predominantly located in 5 states. The lower utilization of DCD lungs, up to 12.7% was equally observed in each state. Over 75%, of DCDs had an agonal time ≤ 30 min in most states except South Florida, eastern Pennsylvania and Colorado/Wyoming. The map colored based on the refusal code categories also showed the geographical differences.

As we continue to increase DCD lung utilization in the United States, better understanding of geographical barriers, adopting universal protocols in DCD organ donation and palliative care will hopefully lead to better utilization of organs from DCD donors, thereby increasing the number of transplants and decreasing organ wait times.