Background: The ideal criteria for lung donation include a "normal" chest x-ray. Due to the shortage of donors, we have to consider taking less than perfect lungs. We take lungs that have an abnormal chest x-ray if the following criteria are met: adequate oxygenation, no signs of infection on bronchoscopy and no palpable consolidation.
Methods: 203 lung transplantations were done, between 1991 to 1998. Out of 203 transplant, 38 recipients, had donor's chest x-rays available for analysis. Chest x-rays were reviewed by blinded chest radiologist and scored according to the degree of air space disease, reticular interstitial changes, and subsegmental atelectasis on post-operative day 1, 3 and 7. Days on ventilator, days in ICU, days in hospital, and mortality at 30, 90 days were evaluated.
Results: Recipients of bilateral lung transplantation. There were 18 females and 20 males, with mean age 41.2 years. We have used 18 lungs with an abnormal chest x-rays and 20 lungs with an ideal chest x-rays. We found that the donor's chest x-rays did not correlate with recipients post-operative chest x-rays on days 1,3 and 7 nor with PO2/FIO2 immediately on arrival in ICU. There was no difference between those patients with a normal and those with abnormal chest x-rays for days on ventilator, days in ICU, days in hospital, mortality at 30 days (3 deaths in these 38 patients all in the normal group), and mortality at 90 days (5 deaths: 3 in normal group, 2 in abnormal group).
Conclusion: In order to increase utilization of donor lungs, use of donor with chest x-ray that are not perfect should be carefully considered. This strategy has lead to successful lung transplantation in a number of cases which might not have been done if strict x-ray criteria had been adhered to. Further work is required to determine the limit of to which this strategy can be pushed.