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Research Snapshot Theater: Transplant Medicine, Adult

Impact of Respiratory Support on Lung Donation Rates: Systematic Review and Meta-Analysis

Tuesday, March 24, 2026
12:30 PM - 1:30 PM Central Time
Location: Connections Central - RST 14

  • Stormie R. Tyler, BS (she/her/hers)

    Indiana

    Disclosure(s): No relevant financial relationship(s) to disclose.

  • JIE LI, PhD, FCCM

    Rush University

    Disclosure(s): AARC: Grant/Research Support (Ongoing), Salary (Ongoing), Speaker/Honoraria (includes speakers bureau, symposia, and expert witness) (Ongoing); COPD foundation: Grant/Research Support (Terminated, November 5, 2025); Fisher & Paykel: Speaker/Honoraria (includes speakers bureau, symposia, and expert witness) (Terminated, November 5, 2025); MEK ICS Ltd: Grant/Research Support (Ongoing)

Introduction: Various respiratory support modalities has been explored to improve lung procurement rates in organ donors. However, current practices lack robust evidence, and the effectiveness of specific interventions remains unclear


Methods: This systematic review and meta-analysis followed PRISMA guidelines. We searched PubMed through July 23, 2025 for randomized controlled trials (RCTs) and non-randomized studies comparing respiratory support interventions—including lung protective ventilation, recruitment maneuver, and prone positioning (alone or in combination)—with standard care in organ donors. The primary outcome was the number of successful lung donors. Secondary outcomes included the number of potential lung donors, final PaO2/FiO2 ratio prior to procurement, and duration of mechanical ventilation. Treatment effects were estimated using a random effects model


Results: We included 13 studies (4 RCTs and 9 non-RCTs). Compared to standard care, respiratory support interventions significantly increased the number of successful lung donors (3 RCTs and 7 non-RCTs, n=4543, RR 1.75 [95%CI 1.37-2.25]), particularly with combined treatments with lung protective ventilation and recruitment maneuver (1 RCT and 3 non-RCT, n=3141, RR 2.16 [95%CI 1.29-3.61]) and prone positioning (2 non-RCT, n=2759, RR 1.58 [95%ci 1.32-1.88]). The number of potential lung donors also significantly increased (2 RCTs and 3 non-RCTs, n =662, RR 2.20 [95%CI 1.15-4.21]). No significant differences were found in the final PaO2/FiO2 ratio or duration of mechanical ventilation


Conclusions: Respiratory support strategies—particularly prone positioning and the combined use of lung protective ventilation and recruitment maneuvers—appear to improve the number of successful and potential lung donors. These interventions do not significantly affect final oxygenation or mechanical ventilation duration. Further high-quality studies with larger sample sizes are needed to confirm these findings and guide clinical practice