Green Channel of Human Organ Transport Improved the Utilization Rate of Chinese Citizens’ Donated Lungs: A Single-Center Data Analysis
Organ donation after the citizen’s death program was fully launched in China in 2015. According to the allocation regulations of donated organs, all donated lungs must be allocated through the China Organ Transplant Response System (COTRS). To fully optimize the implementation of organ transportation sharing policy and coordinate multiple government departments and social groups involved in the process, the “Green Channel of Human Organ Transport (GCHOT)” was established on May 6th, 2016 in China. This study reviewed and compared the status of lung transportation between the pre- and post-GCHOT periods based on data collected from the largest lung transplantation (LT) center in Wuxi, Jiangsu, China, with the aim of introducing the detailed process and implementation of GCHOT in China.
The study was reviewed and approved by the Medical Ethics Committee of Nanjing Medical University. All lungs were from volunteer donation after the death of a Chinese citizen, and each next-of-kin voluntarily provided written informed consent. The Institutional Ethics Committees of the Organ Procurement Organization approved the donation procedures. Donor lungs were allocated through COTRS with comprehensive consideration of the recipients’ body size, blood type, urgency status, and the time spent on the waiting list.
The demographic and transport-related data for all donors and donor lungs between January 1st, 2015 and December 31st, 2018 were collected retrospectively from the electronic medical record system and clinical documents in Wuxi Lung Transplant Center. Demographic indicators for individual donation included gender, age, donor type, and donor hospital. The transport-related data included time spent on transportation, types of transportation, routes, distances, and whether the organs were transported through GCHOT.
Continuous variables with non-normal distribution were shown as the median (Q1, Q3), and categorical variables were presented as numbers and percentages. Comparisons of categorical variables were performed using Chi-square tests, and continuous variables were analyzed using Mann-Whitney U tests. All data were analyzed using the Statistical Package for Social Sciences (SPSS) version 20.0. Statistical significance was set at a P value of <0.05.
A total of 452 donor lungs were transported successfully from January 1st, 2015 to December 31st, 2018. Among these, 131 (29.0%) were transported in the pre-GCHOT era and 321 (71.0%) were transported in the post-GCHOT era. Among the 452 donor lungs received by recipients admitted to Wuxi Lung Transplant Center, 78.5% (355/452) were from organ donors who resided outside Jiangsu province. Donated lungs from Jiangsu province accounted for only 21.5% (97/452) of all donated organs. Donated lungs from Guangdong province, Beijing, and Shandong province accounted for 60.8% (275/452) of all grafts. Twenty-three provinces contributed to lung donation post-GCHOT, while only 16 provinces contributed in the pre-GCHOT period. The proportion of donated lungs from areas outside Jiangsu province also increased from 64.9% (85/131) in the pre-GCHOT era to 84.1% (270/321) in the post-GCHOT era.
Overall, an average of 9.0 (interquartile range [IQR]: 5.5–11.0) donor lungs were transported per month in the pre-GCHOT era, while an average of 10.0 (IQR: 8.0–12.8) were transported in the post-GCHOT era. The median number of donor lungs transported from provinces outside Jiangsu was 7.5 (IQR: 4.3–10.0) per month. In general, the number of donor lungs transported per month from provinces outside Jiangsu increased dramatically from 5.0 (IQR: 3.3–7.0) in the pre-GCHOT era to 9.0 (IQR: 6.0–11.0) in the post-GCHOT era.
The type of transportation utilized included “Air Plus Expressway,” which was the predominant type of transportation accounting for 44.9% (203/452), followed by “Expressway Only” (26.3%, 119/452), “Air Plus High-speed Train Plus Expressway” (14.6%, 66/452), and “High-Speed Train Plus Expressway” (12.6%, 57/452). In addition, 1.5% (7/452) of the grafts were transported within the hospital. Air travel was the most feasible and time-saving choice for transporting lungs from long-distance donation centers, and it accounted for as much as 50.4% (66/131) of transportation routes that were used before GCHOT was established. However, the normal procedures of boarding a flight, such as security checks and waiting time, can take more than 3 hours. In addition, there are flight delays and unfavorable weather conditions, particularly in the Wuxi area in certain periods of the year, all of which adds to delays in air transportation. In the post-GCHOT period, 208 donor lungs were transported through GCHOT, accounting for 64.8% (208/321) of all donor lungs in the post-GCHOT era. All air transportations (203 grafts), including 144 grafts by “Air Plus Expressway” and 59 grafts by “Air Plus High-speed Rail Plus Expressway” were transported by GCHOT. Furthermore, 3 “High-speed Rail Plus Expressway” and 2 “Expressway” transportations were completed by GCHOT. Interestingly, the proportion of air transportation during the post-GCHOT period (63.2%, 203/321) was significantly higher than that in the pre-GCHOT period (50.4%, 66/131).
The overall transportation time per 100 km decreased from 0.9 (IQR: 0.5–1.6) hours in the pre-GCHOT era to 0.5 hours (IQR: 0.4–0.9) in the post-GCHOT era. Of the nine provinces involved in GCHOT (Henan, Chongqing, and Sichuan were excluded from the analysis because of lack of data from the pre-GCHOT era), four provinces (Shandong, Beijing, Guangdong, and Guangxi) had shorter transportation time per 100 km in the post-GCHOT period. The transportation time per 100 km decreased from 0.9 (IQR: 0.9–1.0) hours, 0.5 (IQR: 0.5–0.6) hours, 0.5 (IQR: 0.4–0.5) hours, and 0.4 (IQR: 0.4–0.5) hours, respectively in the pre-GCHOT era, to 0.8 (IQR: 0.8–0.9) hours, 0.5 (IQR: 0.4–0.5) hours, 0.4 (IQR: 0.3–0.4) hours, and 0.3 (IQR: 0.3–0.4) hours in Shandong, Beijing, Guangdong, and Guangxi, respectively, in the post-GCHOT era. On the other hand, the transportation time per 100 km of the two provinces (Jiangsu and Zhejiang) that were not involved in GCHOT (Shanghai was excluded from the analysis because of lack of data from the pre-GCHOT era) in the post-GCHOT period did not differ significantly compared with that in the pre-GCHOT period.
Given that the LT centers are unevenly distributed in the northern, eastern, and southern parts of China, utilization of donated lungs is heavily dependent on the effectiveness of the mode of organ transportation. By virtue of GCHOT, the lung procurement team spent less time on security checks and boarding flights or trains. Most donations were not scheduled, and when public transportation facilities were needed, the tickets were always sold out in the busy time. Staff who were notified to serve under GCHOT could help by reserving seats and space for the organ transportation containers. In the event that seats are unavailable for organ procurement staff, cabin crew members could be entrusted to help carry the organ containers on their own to the receiving end, thus guaranteeing the shortest time of graft ischemia.
Benefitting from the effective implementation of GCHOT, the number of LTs increased rapidly after GCHOT was established. As reported by the China Lung Transplantation Registry and Data Center, the number of LTs has increased from 118 in 2015 to 403 in 2018. Through GCHOT, lung grafts in distant locations, which previously could not be effectively transported over long distances, can now be procured in a timely manner and used to save lives within the minimum transportation time.
Single-center data analysis from Wuxi showed that the number of provinces for donor lungs, the median number of transported donor lungs per month from areas outside Jiangsu province, and the proportion of air transportation in the post-GCHOT era were higher than those in the pre-GCHOT era. Concurrently, the overall transportation time per 100 km after the establishment of GCHOT was shorter than that of pre-GCHOT. Our experience demonstrates that the establishment of GCHOT played a critical role in addressing the gap between lung donation and transplantation. With the rapid development of organ donation in China, GCHOT will continue to contribute to improvements in organ transplantation.
doi.org/10.1097/CM9.0000000000001325
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