What is included in the preoperative evaluation of lung transplantation donors?

Updated: Aug 19, 2019
  • Author: Bryan A Whitson, MD, PhD; Chief Editor: Mary C Mancini, MD, PhD, MMM  more...
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Answer

Criteria for lung donation identify donors with evidence of good gas exchange and an absence of infection of the airway or parenchyma. The donor lung should appear healthy on chest radiographs. Donor lungs should be within 25-30% of the predicted size of the recipient's lungs. Ideally, patients who have COPD should be matched with donors who are between 3 and 5 cm of the recipient height. For patients who have restrictive disease, the donor lungs should be slightly undersized, ie, the donor's height should be within 2 cm of the recipient's height.

All potential donors need to undergo bedside bronchoscopy. A gram stain and culture are taken of the bronchoalveolar fluid and sent for immediate analysis. Upon bronchoscopy, the finding of diffuse bronchial mucosal inflammation is a contraindication for harvesting. However, lungs with purulent secretions that cannot be cleared with bronchoscopy and without mucosal inflammation, in the presence of a clear chest radiograph and preserved gas exchange, are suitable for donation.

In particular, the blood gas on 100% oxygen, which is referred to the challenge gas, should remain greater than 300 mm Hg. The donor should ideally have no more than a 20 pack-year history of smoking. In the United Kingdom, transplantation using lungs from donors with positive smoking histories improves the overall survival of patients. Even though lungs from these donors are associated with worse outcomes, the probability of survival is greater if they are accepted than if the patient waits for a lung from a donor with a negative smoking history. [34]

If found to be suitable, the donor still needs to undergo intraoperative evaluation of the organs. Intraoperative inspection of the pleural space and lung is performed to assess unsuspected trauma, bullous disease, or mass lesions. Recruitment maneuvers may be performed intraoperatively to assure atelectasis is minimized. Pulmonary vein gases may also be collected intraoperatively to ensure good oxygenation of the patient, which, again, should be greater than 300 mm Hg on 100% oxygen.


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