To investigate the association between bronchoscopy frequency and successful lung procurement among potential brain-dead donors, and to evaluate its potential impact on donor lung quality and safety, with the aim of providing evidence to optimize donor management strategies.

A retrospective analysis was conducted on 251 potential brain-dead donors who underwent organ donation in the intensive care unit of Sun Yat-sen Memorial Hospital, Sun Yat-sen University, between January 2020 and January 2024. According to the frequency of bronchoscopic procedures performed during hospitalization, donors were divided into a low-frequency group (n=131) and a high-frequency group (n=120). Propensity score matching (PSM) was performed at a 1 ∶1 ratio, yielding 77 matched donors in each group. Baseline characteristics were systematically collected using the hospital′s artificial intelligence–based big data platform. Continuous variables with normal distribution were compared using independent-sample t tests, whereas non-normally distributed variables were compared using the Mann-Whitney U test. Categorical variables were compared using the chi-square test or Fisher′s exact test. Multivariable Logistic regression, propensity score-adjusted Logistic regression, and weighted models were applied to examine the association between bronchoscopy frequency and successful lung procurement. A P value <0.05 was considered statistically significant.

Before PSM, the successful lung procurement rates were 30.5% (40/131) in the low-frequency group and 41.7% (50/120) in the high-frequency group. After PSM, the corresponding rates were 28.6% (22/77) and 42.9% (33/77), respectively. Substantial differences in baseline characteristics between the two groups were observed before matching, which were markedly reduced after PSM. In the unadjusted regression model, no statistically significant difference in successful lung procurement rate was observed between groups (P>0.05). However, multivariable Logistic regression analysis showed a significantly higher likelihood of successful lung procurement rate in the high-frequency group (OR=3.33, 95%CI: 1.66-6.67; P<0.05). Consistent results were obtained using propensity score-adjusted Logistic regression model (OR=2.29, 95%CI: 1.27-4.15), inverse probability weighting model (OR=2.18, 95%CI: 1.29-3.69), standardized mortality ratio weighting model (OR=2.13, 95%CI: 1.24-3.66), and stratified weighting model (OR=3.33, 95%CI: 1.66-6.67), all indicating significantly higher procurement success rates in the high-frequency group (all P<0.05). After PSM, no significant difference was observed between the two groups in pre-donation coagulation parameters, infection-related markers, or ventilator settings (all P>0.05).

A higher frequency of bronchoscopic procedures was associated with an increased rate of successful lung procurement among potential brain-dead donors, without a significant increase in airway-related or systemic complications.