Leveraging centralization of deceased organ donor management to improve lung transplantation outcomes

PROJECT SUMMARY / ABSTRACT Lung transplantation is a lifesaving yet critically scarce treatment. Only 2% of 160,000 US patients with end- stage lung disease received transplants in 2023. Lung availability is predicated on public willingness to donate organs and is further limited by comorbid diseases and perimortem injuries: only 20% of deceased organ donors donated lungs in 2023. While donor-specific interventions may prevent or treat some lung injuries, clinical expertise, resources, and resulting donation outcomes vary across hospitals. One proposed solution is transferring deceased donors from hospitals to regional specialty donor care units (DCUs), which are expected to improve the number and quality of transplantable organs through concentrated expertise and standardized management. Because each donor may donate organs to up to 8 recipients, DCU adoption potentially impacts an enormous group of patients and clinicians interconnected in the national donation and transplantation system. Despite the effectiveness of healthcare centralization in other populations, specific evidence supporting DCUs is limited to short-term donation and operational outcomes. Moreover, DCUs do not operate in all US regions, and even when a DCU is available, not all donors are transferred (e.g., due to clinical instability). Thus, significant questions remain regarding the unexplored, unforeseen, or unintended consequences of adoption for diverse stakeholders and the optimal use of DCUs to improve donation system outcomes, specifically patients' access to transplantation. During the proposed K23 Mentored Career Development Award, the candidate, Dr. Vail, will test the Central Hypothesis that the impact of ongoing organ donor centralization in the US extends beyond donors transferred to DCUs. Using advanced observational methods in preexisting and prospectively collected data, she will examine three Specific Aims: 1) Test the broad impact of DCU opening on lung donation and transplant outcomes, 2) Identify characteristics of donor transfer networks associated with higher lung donation rates, and 3) Map donor care unit operations and outcome priorities of patients and professional stakeholders. Guided by an experienced team of mentors (Drs. Neuman, Christie, and Kerlin) and expert methods and policy advisors, Dr. Vail's plan leverages the University of Pennsylvania's rich training environment and clinical resources (lung transplant program and affiliated DCU) to ensure that she achieves her short-term methodologic goals (advanced causal inference, geospatial, network, and qualitative analyses) and professional learning goals (1) Healthcare policy assessment and development and 2) Dissemination of research to policymakers) while generating preliminary data to inform competitive R21 and R01 proposals. Through this comprehensive plan, Dr. Vail will take crucial steps toward her long-term goal of becoming an independent health services researcher poised to improve access to lung transplantation and recipient outcomes through rigorous research designed to inform innovation in donor management and policy.