Cross-Regional Unmanned Aircraft Transport of Donor Lungs

Feasibility and Timeliness of Cross-Regional Unmanned Aircraft Transport of Donor Lungs: A Prospective Single-Arm Clinical Study

This prospective, single-arm study will evaluate the feasibility, timeliness, operational reliability, and preliminary safety of transporting donor lungs by a long-range unmanned aircraft system from Nanning to Guangzhou, China. Adult lung transplant candidates will be enrolled after a donor lung has been legally allocated and clinically accepted and after written informed consent has been obtained. Each formally activated transport task will use standard donor-lung perfusion and cold preservation, triple sterile packaging, and a dedicated transport container with continuous monitoring of temperature, vibration, pressure, position, and communication status. The primary outcome is the actual door-to-door transport time from the donor operating room exit to the recipient operating room entry. Secondary outcomes include transport success, time saved compared with contemporaneous ground-transport estimates, lung preservation and ischemic times, transport-environment performance, donor-lung condition on arrival, and early recipient and graft outcomes through 90 days after transplantation. Twenty-five participants corresponding to 25 formally activated donor-lung transport tasks are planned.

The study will be conducted between the Second Affiliated Hospital of Guangxi Medical University in Nanning, the donor-lung transport origin, and the First Affiliated Hospital of Guangzhou Medical University, Datansha Campus, the receiving and transplant center. The planned route is approximately 570 km. The study does not include a concurrent physical ground-transport arm. For each activated task, real-time estimated arrival times for ground transport will be obtained from two prespecified map platforms at the same origin, destination, and reference time. These estimates are an external task-level benchmark for transport efficiency and will not be interpreted as a randomized or parallel clinical control.

Each formally activated task is the primary operational unit of analysis. A bilateral donor-lung shipment intended for one recipient is counted as one task. After clinical acceptance of the donor lung and confirmation of participant eligibility, the lung will undergo standard perfusion, cold preservation, triple sterile packaging, identity verification, and loading into a validated transport container. The unmanned aircraft will fly an approved route under continuous flight and environmental monitoring. A ground backup transport plan will remain available. If medical, weather, airspace, aircraft, communication, energy, or landing-site conditions become unacceptable, the task may be delayed, canceled, returned, diverted, or transferred to ground transport. All activated tasks, including tasks that do not take off or do not complete unmanned transport, will remain in the transport-task analysis set.

The primary outcome is actual door-to-door donor-lung transport time, calculated in minutes from the time the lung exits the donor operating room (T1) to the time it enters the recipient operating room (T6). Key secondary outcomes include the proportion of activated tasks completed successfully, absolute and relative time gain versus contemporaneous ground-transport estimates, lung preservation and ischemic times, temperature stability, vibration and shock, pressure change, communication-link availability, packaging integrity, and donor-lung utilization. Recipients who undergo transplantation with a study-transported donor lung will be evaluated for primary graft dysfunction, perioperative complications, intensive care and hospital length of stay, graft survival, and participant survival through postoperative day 90.

Donor-lung acceptance, recipient selection, transplantation, and postoperative treatment will follow routine clinical standards and will remain independent of study efficiency targets. Prespecified pause rules include any catastrophic transport event, loss or non-recovery of the donor lung, a clearly transport-related organ discard, a serious aviation accident, or a participant death considered clearly or highly likely related to the transport intervention.

Inclusion Criteria

1. The donor lung has been donated, allocated, procured, and assigned in accordance with applicable Chinese laws, regulations, allocation rules, and ethical requirements, and has been allocated to a lung transplant candidate at the First Affiliated Hospital of Guangzhou Medical University.
2. The donor lung is considered clinically suitable for transplantation by both the procurement team and the recipient transplant team and is intended for single or bilateral lung transplantation.
3. The donor-lung procurement location, transplant location, and transport route conform to the prespecified Nanning-to-Guangzhou cross-regional unmanned-aircraft scenario.
4. After standard perfusion, cold preservation, and triple sterile packaging, the donor-lung package meets the transport-container and aircraft requirements for weight, dimensions, fixation, and preservation.
5. The participant is 18 years of age or older, meets clinical indications for lung transplantation, and is considered medically suitable to undergo single or bilateral lung transplantation.
6. The participant or legally authorized representative has provided written informed consent for the study before formal task activation.
7. Before activation, the aircraft, propulsion, navigation, communication, monitoring equipment, landing sites, weather, airspace, route, energy reserve, and backup transport plan meet prespecified operational criteria.
8. The main transport timestamps, environmental and flight-engineering data, and participant follow-up through postoperative day 90 are expected to be obtainable.

Exclusion Criteria

1. The donor lung is considered unsuitable for transplantation or has been definitively declined before task activation.
2. The donation, allocation, procurement, transport, or transplantation process does not comply with applicable legal, ethical, institutional, or protocol requirements.
3. The packaged donor lung does not meet aircraft or transport-container requirements for weight, dimensions, fixation, packaging, or preservation.
4. The participant is younger than 18 years.
5. The participant is planned for combined heart-lung transplantation, another multi-organ transplantation, or repeat lung transplantation.
6. The participant is clinically unstable, the transplant procedure has been canceled or materially changed, or the transplant team considers the participant unsuitable to proceed with transplantation.
7. The participant or legally authorized representative declines participation or valid informed consent cannot be obtained.
8. Before task activation, weather, airspace, route, landing site, aircraft, propulsion, navigation, communication, monitoring, or energy-reserve conditions fail to meet prespecified operational criteria.
9. A reliable backup transport plan cannot be established, or the study team determines that unmanned-aircraft transport would create an unacceptable risk of donor-lung loss, delay, contamination, or damage.
10. Complete primary timestamps or key engineering parameters are not expected to be obtainable, or postoperative day-90 follow-up is not expected to be feasible.
11. The investigator identifies another medical, ethical, operational, or safety reason that makes study participation inappropriate.