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Living Related Lung Transplantation

Lobar lung transplantation is becoming an alternative for those patients who are too critically ill to survive the waiting list for cadaveric donors. The donors are friends or family members of the patient. There are two donors, each donating a lobe to the recipient. Donor lobectomies for living-related lobar transplantation require a thorough evaluation of potential donors, as well as modification of standard lobectomy and pulmonary preservation techniques.

Living-Related Double Lobar Lung Transplant
Illustration demonstrating the portion of each donor lung to be transplanted into patient recipient.The two lobes have the ability to provide normal function, accounting for the increasing popularity of this type of transplantation.
Illustration demonstrating the portion of each donor lung to be transplanted into patient recipient.
The two lobes have the ability to provide normal function, accounting for the increasing popularity of this type of transplantation.

The first step in becoming a donor is to determine the blood type and lung function capacity by spirometry in the Pulmonary Function Laboratory. There will be numerous diagnostic and blood tests performed. The results of the tests will determine donor suitability. The lower lobe from each donor will be taken and placed into the recipient to take the place of their diseased lungs.

After appropriate donors are identified, one is selected for right lower lobectomy and the other for left lower lobectomy. In our experience, the donors do well after surgery. They are up walking 24-48 hours post operatively and usually are discharged in 1-2 weeks. The long term effects for the donors are minimal to none.

The transplantation procedure is as follows:

Figure 1. Dissection and division of the pulmonary artery for donor right lower lobectomy.
Figure 1. Dissection and division of the pulmonary artery for donor right lower lobectomy.

 

Figure 2. Dissection of the right inferior pulmonary vein so that a vascular clamp can be placed on the intrapericardial left atrium.
Figure 2. Dissection of the right inferior pulmonary vein so that a vascular clamp can be placed on the intrapericardial left atrium.

 

Figure 3. Dissection and division of the bronchus to the right lower lobe.
Figure 3. Dissection and division of the bronchus to the right lower lobe.

 

Figure 4. Dissection and division of the pulmonary artery for donor left lower lobectomy.
Figure 4. Dissection and division of the pulmonary artery for donor left lower lobectomy.

 

Figure 5. Dissection and division of the bronchus to the left lower lobe.
Figure 5. Dissection and division of the bronchus to the left lower lobe.

As recipient lists for patients in need of lung transplantation continue to grow, donor availability remains constant. Therefore, many patients with end-stage pulmonary disease will die while waiting for donor lungs. We believe that donor left and right lower lobectomies for living-related bilateral transplantation provide a source of donor lungs for selected patients in need of bilateral lung transplantation.

 

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