The increasing contribution of organ donation after euthanasia to the lung transplantation donor pool in the Netherlands

The number of organ donation after euthanasia (ODE) procedures in the Netherlands has grown substantially, yet their contribution to the lung donor pool remains unclear. There is no clinical consensus on how these potential ODE lung donors should be assessed. We aimed to describe the total contribution of ODE to the lung donor pool in the Netherlands and describe the assessment of potential ODE lung donors. We collected data from all ODE procedures performed between 2012 and 2024 in the Netherlands. We assessed the number of ODE lungs offered, rejected, accepted, and transplanted, comparing characteristics of discarded and transplanted lungs. Of 1166 lung donors, 664 (60%) were donation after circulatory death donors, of which 154 (23%) were ODE lung donors. The total proportion of donor lungs from ODE lung donors acceptable to offer for lung transplantation was 117, of which 104 (89%) were transplanted. Evaluation prior to donation was highly variable, with medical history and chest computed tomography most affecting acceptance decisions. Short-term outcomes were excellent, with 1-year survival of 84%. Our findings indicate that ODE lung donors are increasingly important in the Netherlands, with high acceptance rates, despite highly variable evaluation methods. Standardizing the assessment of potential ODE lung donors could further improve acceptance rates and enhance the contribution of ODE to the lung donor pool.