Lung donation and donor lung management: a survey among health care professionals in Argentina

Vanesa Romina Ruiz, Sergio Adrián Terrasa, Susana Bauque, Pablo Ezequiel Rodriguez, Verónica Celia Morozovsky, Alejandro Gabriel Da Lozzo, Alejandro Daniel Midley

To describe health care providers' knowledge about lung donation and donor lung management. A descriptive, cross-sectional study based on an anonymous survey was conducted between March and September 2018 among health care professionals registered to Sociedad Argentina de Terapia Intensiva. Of the 736 respondents, the mean age was 40.5 years (standard deviation 8.9), and 61.3% were female. Sixty percent were physicians, 21.5% were nurses, and 17.9% were physiotherapists. Seventy-eight percent considered themselves appropriately informed about organ procurement, and 79.8% stated that they knew potential organ donor critical care management. The lung donor criteria were answered correctly by 71.3% of the respondents. However, after the donor's brain death, 51% made no changes to ventilator parameters, 22.9% were not aware of which parameters to reprogram, and 44.5% selected tidal volume of 6 - 8mL/kg and positive end expiratory pressure of 5cmH2O. For 85% of the health care providers, the type of apnea test chosen was disconnection from the ventilator, and only 18.5% used a lung management protocol. The most frequent interventions used in the case of arterial oxygen partial pressure/fractional inspired oxygen < 300 were positive end expiratory pressure titration, closed-circuit endotracheal suctioning, and recruitment maneuvers. Health care professionals surveyed in Argentina correctly answered most of the questions related to lung donor criteria. However, they lacked detailed knowledge about ventilatory settings, ventilatory strategies, and protocols for lung donors. Educational programs are key to optimizing multiorgan donation and should be focused on protecting the donor lungs to increase the numbers of organs available for transplantation.