HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): John V. Conte Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Conte, J. V. Search for Related Content PubMed Articles by Conte, J. V. Related Collections Lung - transplantation Related Article

Ann Thorac Surg 2002;73:1604-1605
© 2002 The Society of Thoracic Surgeons

Invited commentary

^a Johns Hopkins Medical Institutions, Divisions of Cardiac Surgery, Blalock 618, 600 North Wolfe Street, Baltimore, MD21287, USA

e-mail: jconte{at}csurg.jhmi.edu

The discrepancy between supply and demand in lung transplantation grows yearly. Due to the susceptibility of the lung to infection and injury in potential organ donors, the percentage of donors suitable for lung donation remains in the 20% range. Transplant professionals have been forced to explore the use of nonstandard donors to serve their patients. Aggressive programs have been quite liberal in accepting donors with imperfect radiographs, bronchoscopic findings of inflammation, and arterial oxygen tension (PaO₂) levels below 300 mm Hg. The outcomes with the use of such donors has been routinely equivalent to those of standard donors.

PaO₂ has traditionally been the most commonly used method of assessing suitability of donor lung function. The article by Aziz and associates show that blood samples drawn from a radial arterial line may not accurately reflect the oxygen exchange function of individual lungs and that individual vein gas (PvO₂) samples do. They show that lungs with acceptable PvO₂ levels, but poor radial artery PaO₂ samples, do equally well following transplantation. They confirm the findings of Puskas and associates who used a cumbersome method of double lumen intubation and unilateral pulmonary artery clamping to assess individual lung function. This simple, intuitive, test allowed their program to transplant 42 lungs, which may have otherwise not been used and achieved lung utilization rates far higher than the national average.

The obvious response to this study is that all programs should use PvO₂ to assess lungs and increase the yield of lungs for lung transplantation; however, it is not that easy. In the U.S., if a program flies out to inspect the lungs of a potential donor and the lungs are found not to be acceptable, that program and/or their organ procurement organization eats the cost of going out to inspect the organs. This is cost prohibitive for nearly all programs. Two potential solutions to this problem are regional organ procurement teams for all thoracic organs or a program of federal funding of the cost of organ procurement to encourage programs to go all out to find usable donors. Discussions need to begin to explore these and other potential options if we are to truly achieve maximal lung utilization for our transplant recipients.1

References

1. Puskas J.D., Winton T.L., Miller J.D., et al. Unilateral donor dysfunction does not preclude successful contralateral lung transplantation. J Thorac Cardiovasc Surg 1992;103:1015-1018.[Abstract]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): John V. Conte Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Conte, J. V. Search for Related Content PubMed Articles by Conte, J. V. Related Collections Lung - transplantation Related Article