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Lung transplantation: Donor lung preservation

Marcelo Cypel, MD, MSc
Tom Waddell, MD, MSc, PhD, FRCS, FACS
Shaf Keshavjee, MD, MSc, FRCSC, FACS
Section Editor
Elbert P Trulock, MD
Deputy Editor
Helen Hollingsworth, MD


Donor lung preservation refers to the process of maintaining and protecting a donor lung from the time of lung procurement up until implantation in the recipient. Many factors such as temperature, perfusion volume and pressure, oxygenation, and degree of inflation may impact the likelihood of lung injury during storage or at the time of reperfusion, and also the function of the lung after transplantation.

Much of the experimental work in lung transplantation over the past decade has focused on optimizing methods of lung preservation to reduce the impact of ischemia-reperfusion injury on post-transplant lung function.

The preservation of donor lungs for lung transplantation will be reviewed here. An overview of lung transplantation and discussions of donor evaluation and management, the lung transplantation procedure, early postoperative care, and primary graft dysfunction are provided separately. (See "Lung transplantation: An overview" and "Lung transplantation: Deceased donor evaluation and management" and "Lung transplantation: Procedure and postoperative management" and "Primary lung graft dysfunction".)


The donor lung procurement operation is coordinated with cardiac procurement, such that the lungs and the heart may routinely be used for separate recipients (table 1) [1]. Key goals include preventing in situ thrombosis and vasospasm and stabilizing the lung for static cold storage. Lung donation after brain death or cardiac death is discussed separately. (See "Lung transplantation: Deceased donor evaluation and management", section on 'Donation after brain death' and "Lung transplantation: Deceased donor evaluation and management", section on 'Donation after cardiac death'.)

Donation after brain death — The lung procurement operation is usually performed through a median sternotomy [1,2]. In sequence, the pulmonary arteries are dissected free from the ascending aorta and the superior vena cava is dissected free up to the innominate bifurcation. After the heart and lungs are exposed, the donor is anticoagulated with intravenous heparin (300 units per kg). A perfusion cannula is placed in the pulmonary artery at least 1.5 cm distal to the pulmonary valve. A cardioplegia catheter is placed in the ascending aorta. (See "Diagnosis of brain death".)

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Literature review current through: Oct 2017. | This topic last updated: Mar 09, 2016.
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