Each year, thousands of people in the United States receive a lifesaving organ transplant. Still, due to a shortage of donor organs, more than 100,000 patients await a donated organ, and more than 10,000 die while waiting or become too sick for transplant surgery.
“One of the reasons for the organ shortage is that in the United States, usually death must occur in a hospital in an expected way to be eligible for organ donation. Since most deaths are unexpected, those who wanted to donate their organs often don’t get the chance,” says Robert Montgomery, MD, PhD, chair of the Department of Surgery and director of the NYU Langone Transplant Institute.
To potentially increase the number of viable donor lungs available for transplant, Dr. Montgomery and Stephen P. Wall, MD, an emergency medicine clinician at the Ronald O. Perelman Department of Emergency Medicine at NYU Langone, are leading a study funded by the National Heart, Lung, and Blood Institute to assess a new lung recovery protocol aimed at transforming the lung donation process.
The NYU Uncontrolled Donation after Circulatory Death (uDCD) study, which begins in December 2024, will evaluate lung donation for those who die of unexpected cardiac arrest (e.g., a heart attack) in the hospital emergency department.
“In this new study, we’re focusing on lung donation, because lungs are more resistant to damage after cardiac arrest than other organs and lungs. There aren’t any alternatives, such as dialysis for kidneys or living donation to extend life,” Dr. Wall said.
How the New Lung Recovery Protocol Works
The new lung recovery protocol will involve patients who die unexpectedly from cardiac arrest in the emergency department. The lungs will be kept partially inflated, using the same airway devices used in resuscitation to deliver oxygen, which helps protect the lungs for transplant.
“Maintaining partial lung inflation with oxygen will not change or damage the body,” Dr. Montgomery said. Partial inflation will occur only after all resuscitative efforts have been made. “Study protocols will ensure that saving lives is always chosen over preserving organs,” Dr. Montgomery said.
Maintaining partial lung inflation for up to three hours after death can be performed without requiring preauthorization. This practice is supported by the legal requirement in the New York Anatomical Gift Act to preserve the suitability of organs for donation until a donation decision can be ascertained, either by learning of first-person authorization or authorization from family members.
Actual lung recovery for transplantation can only begin after authorized persons are contacted and agree to provide authorization for lung donation. If authorized persons decline or can’t be reached after 2 hours and 30 minutes, lung inflation will stop and the lungs will not be available for organ donation. For patients registered for organ donation and donation for research, however, lungs will be inflated to realize the wish of the deceased. Family members cannot override a patient’s organ donation decision.
Dr. Wall said protocols for the study were developed “after meeting with representatives from diverse religious and secular organizations.” “We wanted to ensure the study was designed with respect for ethical and cultural norms,” he added.
The new protocol mirrors others already active in Europe and Canada. “It is our hope that translating this organ donation protocol to the United States can increase opportunities for lung donation and save more lives.” Dr. Wall said.
Hospitals Participating in the New Lung Recovery Protocol
NYU Langone is ranked top in the nation for excellent transplant survival, fast transplant rates, and low mortality.
Lung transplantation surgery, which replaces a diseased or failing lung with a healthy lung, usually from a deceased donor involving one or both lungs, can be lifesaving for patients with conditions like these:
- severe cystic fibrosis
- COPD/bronchopulmonary dysplasia
- pulmonary hypertension
- heart disease
- pulmonary fibrosis/sarcoidosis
To potentially ease the lung donation crisis in the United States, emergency departments at NYU Langone’s Tisch Hospital, NYU Langone Hospital—Brooklyn, and NYU Langone Hospital—Long Island are participating in the new lung recovery study.
Patients will be automatically enrolled in the study but may decline to participate by completing a survey to register their decision not to participate or by contacting the study team at 646-761-7210. The study is anticipated to conclude on June 30, 2027.
For assistance or questions about NYU Langone’s new lung recovery study, contact the study team at 646-761-7210.
