Selection and Management of the Lung Donor

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Novel sources of transplantable donor lungs

Traditionally, cadaveric ABO blood-group–matched donation-after-brain death (DBD) double and single LTxs have been almost exclusively used for clinical LTx; however, other organ sources are evolving.

Extending the spectrum of transplantable donor lungs

The potential pool of donor lungs available for transplant has traditionally been reduced by concerns regarding perceived poor function in the donor and the perception of a high risk of failure postoperatively.4 Although available donor lungs can be conceived as an iceberg with only the tip useable (Fig. 1), we contend the situation is quite different.

New techniques of donor evaluation

Oto and colleagues56 describe a high incidence of macroscopic pulmonary emboli (40 of 130 donor lungs) in the pulmonary vein effluent following flushing of donor lungs on the back-table preimplantation. The presence of these emboli (80% thrombi and 20% fat) was associated with a 4.8- and 20.6-fold increase, respectively, in the incidence of primary graft dysfunction (PGD). In this study, the incidence of subsequent PGD was decreased if therapeutic attempts were made to flush out all venous

Resuscitation and optimization of donor lungs

The low use rate of potential donor lungs, in part, is related to the inherent instability of the lungs following brain death. Donor lung injury may arise from direct trauma, aspiration, neurogenic edema, ventilator-associated barotrauma, or ventilator-associated pneumonia.64 However, there are several strategies that can be implemented to aim to reverse the current low procurement rate.

Summary

The gap between the number of available donor lungs and patients waiting for transplant continues to be problematic. Notwithstanding, novel sources of donor lungs, a much broader definition of acceptability criteria, and aggressive management of the lung donor can clearly increase the number of donor lungs available. Prospective studies of novel donor factors and novel assessment techniques are now required to further expand and define acceptability limits. The ultimate aim must be the creation

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    Support for this work comes from the Margaret Pratt Foundation.

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