Donor Selection, Management, and Procurement for Lung Transplantation

Abstract

Lung transplantation is a life-saving procedure in patients with end-stage lung disease. However, it inherently depends on the availability of donor organs. The selection of suitable lungs for transplantation, management of donors to minimize further injury and improve organ function, and safe procurement remain critical for successful transplantation. In this review, we provide an update on the current understanding of donor selection, management, and lung procurement.

Keywords: Donor management; Donor selection; Lung procurement; Lung transplantation.

Fig. 1

Pulmonary artery (PA) cannulation is placed on the main PA 1.5 cm proximal to its bifurcation with the agreement of the heart procurement surgeon. Care should be taken to prevent the cannula tip from entering either the right or left PA. Before perfusion, the superior vena cava is ligated, and the left atrial appendage and inferior vena cava are opened for venting. Once aortic cross clamp is placed, perfusion starts.

Fig. 2

By retracting the apex of the heart, the anterior wall of the left atrium can be easily seen and opened.

Fig. 3

Retrograde perfusion through the pulmonary veins is performed with a Foley catheter (250–500 mL per vein) until the effluent from the pulmonary artery becomes clear.

Fig. 4

The esophagus is the most important anatomical landmark for en bloc resection of the lungs and trachea. From the diaphragm and thoracic inlet, the esophagus is the dissection plane, which is located just below the pericardium and trachea (A, B). The head vessels and superior mediastinal tissue on the right and the left side of the trachea need to be cut for en bloc resection of the lung and trachea (A).

Fig. 5

After retracting the lungs to the opposite side, the anterior wall of the esophagus is the dissection plane from the diaphragm to the thoracic inlet. During the dissection, the descending aorta on the left and the azygos vein on the right are cut.

Fig. 6

After exposure of the trachea, a hole can be made using a finger below the head vessel (innominate and jugular veins and carotid and subclavian arteries) from both sides of the trachea to the apex of both thoracic cavities (A), and all the mediastinal tissue and the head vessel can be cut easily. Then, the trachea is freely dissected from the esophagus (B).