Living donor lung transplantation: Selection, technique, and outcome

Lobar lung transplantation utilizing living donors provides a reasonable alternative for both adult and pediatric patients for whom a cadaveric organ is not available. Because this procedure presents risks to the donors, both recipient and donor selection must be performed carefully. Timing of the living donor transplant should be based on the same degree of severity of illness used to evaluate patients for cadaveric transplant. Close monitoring of the donors in regard to postoperative pulmonary function and exercise capability has demonstrated that this procedure is well tolerated from a physiologic standpoint. Quality-of-life studies have revealed that the great majority of donors have been extremely satisfied with their decision to donate. Despite the concerns regarding risks to the living healthy donors, the results of our experience have demonstrated the safety of this procedure. While there has been no mortality in the donor cohort, a risk of death between 0.5% to 1% should be quoted pending further data. Living-donor lobar donation provides organ availability that can be life saving in severely ill patients who will either die or become unsuitable recipients before a cadaveric organ becomes available. For adult recipients, living donor lung transplantation should be considered as an option for patients with diseases such as cystic fibrosis, pulmonary hypertension, and pulmonary fibrosis, although cadaveric transplantation is the preferred option if the clinical situation will allow the wait. In view of our current results in children5 showing improved survival and decreased bronchiolitis obliterans, we feel that living donor lung transplantation is a reasonable alternative to cadaveric lung transplantation in that population.