Lung transplantation: Deceased donor evaluation and management
- Edward R Garrity, MD, MBA
Edward R Garrity, MD, MBA
- Professor of Medicine
- University of Chicago
Optimal selection and care of donor lungs for transplant are needed to increase the number of available lungs. Deceased donor evaluation, selection, and management after brain and cardiac death will be reviewed here from the lung transplant perspective. Living donor lobar transplants are rare in comparison to deceased donor lung transplants.
The indications for lung transplantation, selection of lung transplant recipients, and donor lung preservation are discussed separately. (See "Lung transplantation: An overview" and "Lung transplantation: General guidelines for recipient selection" and "Lung transplantation: Donor lung preservation".)
DONATION AFTER BRAIN DEATH
Donor evaluation begins with the notification of the local Organ Procurement Organization (OPO) of a potential donor. A member of the OPO, or a provider trained in the consent of families for organ donation, should approach the family as soon as reasonable after the determination of brain death . (See "Diagnosis of brain death".)
When the patient has signed an irrevocable consent for transplant (offered through some state registries), the OPO staff will support the family through the organ retrieval and grieving process. If consent has not already been provided by the patient, the OPO staff will explain the procurement process to the family, including the dignity of the process and implications for funeral arrangements, and obtain their consent . The OPO staff will also coordinate evaluation of the donor for suitability for transplant and will communicate with the United Network for Organ Sharing (UNOS) to match the donor with an appropriate recipient from the waiting list. (See "Lung transplantation: An overview".)
DONATION AFTER CARDIAC DEATH
Donation after cardiac death (also called nonheartbeating donor) has become an accepted method of increasing the donor pool in some transplant centers and organ procurement organizations (OPO), although the exact definition of cardiac death and the timing of organ harvest remain controversial. Nonheartbeating donors can be classified according to the Maastricht system, which was developed in 1995 and revised in 2003 [3,4]:
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- DONATION AFTER BRAIN DEATH
- DONATION AFTER CARDIAC DEATH
- DONOR SELECTION
- Size matching
- Ideal donor criteria
- Expanded donor criteria
- - Advanced donor age
- - ABO compatibility
- - Abnormal chest radiograph
- - Cytomegalovirus antibodies
- - Low PaO2
- - Diabetes mellitus
- - Smoking
- - Malignancy
- - Donor infection
- Ex vivo lung perfusion
- DONOR MANAGEMENT
- Cardiovascular compromise
- Volume repletion
- Electrolyte balance
- Hormonal therapy
- Donor genetics
- SUMMARY AND RECOMMENDATIONS