Donor quality echoes for years after the transplant.
Early lung-graft survival is similar across donor types, but the curves fan apart with time — donor age and DCD status show their cost at 3 and 5 years, not at one. Long-horizon outcomes are where better donor selection compounds.
Source: OPTN/UNOS STAR file, Dec 2025 release · 60,222 lung/heart-lung transplants with donor age and graft follow-up.
85% → 51%
Graft survival for the youngest donors falls from 84.7% at 1 year to 50.6% at 5. Older donors trail by 5.7 pts at 5 years (44.9%), and DCD grafts diverge late — 39.8% vs 48.7% at 5 years.
01 · Donor age
Older donors, lower long-term survival
Graft survival at 1, 3, and 5 years by donor age tier. The gap is small at one year and widens with follow-up.
Graft survival by donor age (%) 18–34 35–49 50+
02 · Donor type
DCD grafts diverge late
DBD and DCD grafts survive almost identically through the first year, then separate — the DCD penalty is a long-horizon phenomenon.
Graft survival by donor type (%) DBD DCD
Because the donor-quality penalty is small at 1 year but real at 5, models trained only on early endpoints under-weight it. Donor-lung assessment that anticipates long-horizon graft survival — not just 72-hour PGD — captures value the short window misses.