Living Donor Lung Transplantation

Abstract

Living donor lobar lung transplantation (LDLLT) was originally developed in the early 1990s, in response to the growing number of patients who were dying while awaiting suitable cadaveric donors for lung transplantation. The procedure involves bilateral lung transplantation using the right lower lobe from one living donor to replace the right lung of the recipient, and the left lower lobe from another living donor to replace the left lung. Because both of the patient’s lungs are replaced by lobes from healthy donors, our early experience was confined to children and young adults with cystic fibrosis who, by virtue of their small size, were predicted to receive adequate pulmonary reserve after receiving only two pulmonary lobes. In order to minimize ethical issues regarding the risks of subjecting two healthy donors to a lobectomy for each transplant, only parents or siblings were originally considered as potential donors. Once successful recipient and donor outcomes and safety were established, the use of living lobar lung transplantation expanded to include recipients with a wide range of pulmonary diseases, including other suppurative diseases of the lung, as well as pulmonary hypertension, pulmonary fibrosis, and pulmonary obstructive disease. Criteria for lung donation have expanded as well. Whereas the number of living donor lung transplants has decreased in the US due to the success of the lung allocation scoring system implemented by the Organ Procurement and Transplantation Network in 2005, its use has expanded in countries like Japan, where waiting times for cadaveric lungs remain exceptionally long.