Improving donor lung evaluation: a new approach to increase organ supply for lung transplantation.

Major technical and pharmacological advances mean that lung transplantation now oVers a realistic opportunity for long term survival in selected patients with end stage pulmonary disease. 1 2 Unfortunately up to 50% of patients identified as suitable candidates to undergo lung transplan-tation will die from their underlying lung disease before an organ becomes available. 3 4 The severe shortage of donor lungs is now the major limitation to the use of the procedure as a widely available therapeutic option. The current method of donor lung evaluation excludes the vast majority of potential lung donors. New objective indices of donor lung injury may help to rationalise the selection process. This would enable many of the previously excluded organs to be accepted, addressing the current problem of organ shortage. Donor lungs originate from ventilated brain dead patients whose relatives have given consent for organ donation. Multiple strategies have been adopted by the transplant community to increase the number of donor organs for all types of solid organ transplantation. Attempts at raising awareness in medical staV to identify potential brain dead donors and in the general public to encourage consent when approached have failed to dramatically increase the number of organs available for transplantation. Despite 25% of the public carrying a donor card, both emotional and cultural reasons within families have prevented this leading to a significant increase in donors. In other countries legislation requiring medical staV to approach all potential donor families and the introduction of opt-out rather than opt-in systems of donation have not resulted in a major increase in the donor pool. 5 To date the attempts at increasing numbers of potential donors have been disappointing and transplant teams have turned to other possible ways of addressing the shortage of donor lungs. Lung transplantation using lobes from living family members has proved a useful procedure in selected cases, especially in teenagers, 6 and results are equivalent to that achieved with cadaveric organs. There are, however, both medical and ethical reservations to its widespread use 7 and it is therefore unlikely to be a viable option for the majority of patients on the lung transplant waiting list. Patients who die suddenly and are not maintained on life support have not previously been considered potential lung donors; however, their kidneys have been used successfully 8 and animal models suggest that " non-heart beating donors " may provide an opportunity to increase the …