Advance with MUSC Health

DCD lungs can shorten wait times for patients awaiting lung transplant

Advance With MUSC Health
December 07, 2021
Two doctors looking at a computer screen.

For someone waiting for a lung transplant, every day - and every breath - matters.

Nationally, wait times are on average 4 months, but can be much longer, depending on patients' specific circumstances.

At MUSC Health, 97.2% of patients awaiting a lung transplant typically receive a lung within one year. Dr. Timothy Whelan, medical director for the Lung Transplant Program, wants to increase that number.

To minimize the wait time for prospective lung transplant patients, MUSC Health has expanded its program to include DCD lungs.

DCD stands for donation after circulatory death and applies to lungs of patients whose circulatory and respiratory functions have irreversibly stopped as a result of terminal illness or injury.

"In these cases, some families may decide to limit or withdraw artificial life-supporting medications or devices," says Dr. Z. Hashmi, an MUSC Health cardiac thoracic surgeon. "If a family decides to take a patient off life support, the patient may be eligible to donate his or her organs once the heart stops beating."

DCD is not new. DCD was first introduced in 1963 by Dr. James Hardy but was abandoned because long-term survival rates were poor. As a result, lungs for transplant were used only from donor patients who had been declared brain dead. Advances in technology in medicine, however, have made DCD transplant a viable option, one that is growing at leading medical centers around the country.

MUSC Health's lung transplant team performed their first DCD lung transplant in September. Hashmi says the patient is recovering well, and the team is optimistic for the future of DCD transplants.
"The ability to use DCD lungs increases the chance for patients on our lung transplant list to receive a lung transplant,' Hashmi says. 'It increases the donor pool and gets patients transplanted more quickly because we have more opportunities to procure strong, healthy lungs."

DCD organs are every bit as good as those taken from a brain-dead donor. The process requires a highly skilled surgical team, Hashmi says.

"This is a more challenging process for donation, so more clinical expertise and postoperative care are necessary for good outcomes," he says.

Hashmi says the success of a DCD lung transplant depends on three key factors: A competent surgeon who can assess the lungs; a seamless system in place for procurement, and a competent surgical and medical team who can perform the transplant and manage it post-operatively.

"We have a highly skilled lung transplant team at MUSC Health," he says. “When our team goes to retrieve DCD lungs, a significant part of the time is spent opening up the chest, inflating the lungs and assessing if they're going to work well or not for the patient," Hashmi says.

After a family has decided to withdraw care, the hospital contacts the national organ donor network, a step mandated by federal law. The organ donor network will screen the patient for eligibility and speak to the family if the network believes the patient is a suitable candidate.

If those steps are successful, the transplant center whose lung transplant patient is next on the list is notified. That medical team then travels to the DCD site to assess the lungs.

Whelan and Hashmi, along with their partners Drs. Barry Gibney and Luca Paoletti, agree that DCD will benefit potential lung transplant patients.

"DCD is a process used by all the high-volume transplant programs. It's beneficial because it increases donor options and the recipient can receive a transplant faster and remain on the wait list for less time," Hashmi says. "As our program grows, we want to show that we're one of these centers that can offer this capability."

Whelan says MUSC Health's survival rate for lung transplant patients is 7 years, compared with 5 and a half to 6 years nationally. Of patients awaiting a lung transplant nationally, 72% receive their new lungs within one year. MUSC transplants at a far higher rate than the national average.

"We are a nationally competitive program, and we are committed to providing the best care and outcomes for our transplant patients," Whelan says. "If we list you for a transplant, we're committed to getting you transplanted. if we get you on the list, you have a 97 percent chance of being transplanted within the year. We believe DCD will help increase that number by providing more opportunities to have more good organs to put in to our patients."

Learn more about the MUSC Health Lung Transplant Program.