• Yuriko Terada, Tsuyoshi Takahashi, Ramsey R Hachem, Jingxia Liu, Chad A Witt, Derek E Byers, GuillametRodrigo VazquezRVDivision of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University, Saint Louis, Mo., Hrishikesh S Kulkarni, Ruben G Nava, Benjamin D Kozower, Bryan F Meyers, Michael K Pasque, G Alexander Patterson, Gary F Marklin, Pirooz Eghtesady, Daniel Kreisel, and Varun Puri.
• Division of Cardiothoracic Surgery, Department of Surgery, Washington University, Saint Louis, Mo.
• J. Thorac. Cardiovasc. Surg. 2023 Nov 1; 166 (5): 13471358.e111347-1358.e11.

ObjectiveNational and institutional data suggest an increase in organ discard rate (donor lungs procured but not implanted) after a new lung allocation policy was introduced in 2017. However, this measure does not include on-site decline rate (donor lungs declined intraoperatively). The objective of this study is to examine the impact of the allocation policy change on on-site decline.MethodsWe used a Washington University (WU) and our local organ procurement organization (Mid-America Transplant [MTS]) database to abstract data on all accepted lung offers from 2014 to 2021. An on-site decline was defined as an event in which the procuring team declined the organs intraoperatively, and the lungs were not procured. Logistic regression models were used to investigate potentially modifiable reasons for decline.ResultsThe overall study cohort comprised 876 accepted lung offers, of which 471 donors were at MTS with WU or others as the accepting center and 405 at other organ procurement organizations with WU as the accepting center. At MTS, the on-site decline rate increased from 4.6% to 10.8% (P = .01) after the policy change. Given the greater likelihood of non-local organ placement and longer travel distance after policy change, the estimated cost of each on-site decline increased from $5727 to $9700. In the overall group, latest partial pressure of oxygen (odds ratio [OR], 0.993; 95% confidence interval [CI], 0.989-0.997), chest trauma (OR, 2.474; CI, 1.018-6.010), chest radiograph abnormality (OR, 2.902; CI, 1.289-6.532), and bronchoscopy abnormality (OR, 3.654; CI, 1.813-7.365) were associated with on-site decline, although lung allocation policy era was unassociated (P = .22).ConclusionsWe found that nearly 8% of accepted lungs are declined on site. Several donor factors were associated with on-site decline, although lung allocation policy change did not have a consistent impact on on-site decline.Copyright © 2023 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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