OPOs face the ongoing challenge of allocating lungs for transplant. Allocation policies regarding the donation service area span a 250-nautical mile radius, negatively impacting the procurement process. As a result, travel distances and costs will increase, and the opportunity to evaluate other lung options, such as donation after circulatory death (DCD), could decrease. These challenges make it necessary for OPOs to find more efficient ways to assess lung donors.
Because DCD success has not differed much from traditional brain-dead donors (DBD), we can expect to see higher DCD usage if apprehension about DCDs is overcome. The goal for OPOs is to help increase the number of viable lung donations to help meet the growing wait list for transplant patients. Here we consider the importance of telepulmonology for OPOs to help expedite the assessment process to increase efficiencies and the number of lung donations.
Donation After Circulatory Death
As we entered the new millennium, successful utilization of lung allograft donation after circulatory death (DCD) increased hopes that lung shortages for transplant would slowly rise. In the U.S. alone, between 1987 and 2007, 36 DCD lungs were transplanted. The International Society of Heart and Lung Transplantation also found a 5-year survival rate for DCD lung recipients, which aligns with rates for DBDs. However, despite facing ongoing lung shortages for waiting patients, there is still hesitancy regarding the utilization of DCD lungs by both OPOs and transplant programs.
Supportive technologies such as ex vivo lung perfusion are critical to DCD success, as is all technology that helps expedite the evaluation process. Using telepulmonology provides additional support to address common challenges of lung procurement. This includes the presence of pulmonologists at remote ICU locations through teleconferencing to assess lung viability. Through remote testing and confirmation of interpretations with specialists, transplant hospitals and OPOs can also help overcome issues in assessing DCD lungs to increase the number of transplantable organs.
Donor Evaluation
The remote evaluation of potential lung transplant donors can help increase lung availability. Through telepulmonology and telepathology, focus can switch from traditional methods based on perceived absolute contraindications such as medical histories, smoking history, and robust pulmonary function to exploring non-ideal donors. Telepulmonology makes it easier for OPOs to base lung donor potential on extended criteria, weighing specific risk factors on post-transplantation allograft function. Remote testing capabilities help identify donors based on patient-specific considerations and organ specifics to expand the potential of finding donors, especially for emergencies.
Through telepathology, information to help score donor viability, such as lab values, test results, and disease diagnosis, allows OPOs and other stakeholders to find acceptable lungs quickly. Considerations such as active infection, size, and oxygenation can be confirmed using technology such as telepulmonology and telepathology solutions. With location an issue, OPOs can also determine viability based on travel time to find the most suitable transplant patient in the area. This helps find a match in nearby hospitals, saving more lives.
Sleep Disordered Breathing and Lung Transplants
The medical community lacks data regarding sleep-disordered breathing (SDB) and severe chronic respiratory failure for patients awaiting lung transplantation. Understanding how lung transplants impact SDB and the prevalence and possible impact of SDB pre and post-lung transplantation will provide insight into new-onset SBD following transplants.
Diagnostics for respiratory sleep disorders through remote board-certified specialists provide insights and clinical judgment to assess the severity of respiratory conditions such as SDB. Remote tests monitor and measure respiration during sleep to:
- Identify sleep-disordered breathing
- Accurately evaluate and interpret findings that simplify diagnosis
- Offer valuable data before and after transplantation
Sleep study assessments include:
- Split-Night PSG Evaluation
- Two-Night PSG Evaluation
- Diagnostic Overnight Polysomnography (PSG)
- Level 1 Sleep Study
- Level 2 Sleep Study
- Level 3 Sleep Study
- Level 4 Sleep Study
Data collected by OPOs and specialists can provide insight to help improve transplant patient outcomes.
Increasing Lung Donations
Technology continues to expand and improve telehealth services, reducing the need for in-person diagnostics. For example, Pulmonary Function Tests (PFTs) performed remotely provide valuable data for OPOs waiting for lung donation. OPOs can measure lung volume, capacity, rates of flow, and gas exchange for quick diagnosis of lung disorders not suited to donor criteria. Testing and assessment are available 24/7, including pulmonary function and sleep study interpretations for patients on wait lists.
Perhaps more importantly, research found that improved donor management protocols increase donor lung utilization rates. ICU units in remote areas without access to a pulmonologist can receive bedside support to follow best practices to preserve and optimize lung function when acquiring donations.
Types of Telepulmonology Services
Patient lung function and oxygen supply can be tested by certified specialists, including:
- Bronchoscopy
- Lung volume test
- Respiratory muscle strength test
- Lung diffusion capacity test
- Altitude simulation tests
- Exercise challenges
- Cardiopulmonary exercise tests
- Methacholine inhalation challenge
- Maximal voluntary volume
- Shunt studies
- Ambulatory oximetry
- Arterial blood gas test
- Body plethysmography
- Exhaled nitric oxide test
- Spirometry
For example, telepulmonology interpretations for spirometry tests help identify pulmonary and chronic obstructive pulmonary diseases in patients nearing death to assess donor potential. As well, remote pulmonologists can assess test quality and provide digital consultation with OPOs and practitioners to collaborate on donor potential.
Rural areas with a higher rate of lung-related conditions lack access to specialized pulmonary testing. These locations can access telepulmonology solutions for patients waiting for donors in these areas. Remote lung assessment, diagnostics, pathology, and teleconferencing contribute to OPO procurement of organs to reach wait list patients in underserved areas.
Certified remote specialists assist in study and diagnostic interpretation at any stage of the lung transplant process with state-of-the-art diagnostic tools. Remote consultation is a cost-effective solution providing real-time interpretation collaboration with specialists to improve outcomes.
Specialist Direct Telepulmonology Solutions
Specialist Direct enables organ procurement organizations and transplant centers to allocate organs faster. We offer Sleep Studies, Pulmonary Function Tests, Telepulmonology Interpretations, and remote consultations with a team of board-certified specialists. Reach out to our team today.
