Friday, October 10, 2008

Living Donor Lung Transplant?

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.

Lobar lung transplantation was pioneered by Dr. Starnes at USC University Hospital and provides an alternative therapy for severely ill patients who are unlikely to survive the waiting that is often required for cadaveric organs to be available. Dr. Starnes was the first in the world to perform a living-related double lobar lung transplant on a patient with cystic fibrosis. Strict criteria must be met before a patient can qualify for these living related procedures.

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 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 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.

Dr. Starnes at USC performed my transplant. My mom donated her right lower lobe, and a family friend donated his left lower lobe. USC is a small hospital (extremly small compared to our UAB), but had an excellent and very well known transplant team. Since the UNOS guidelines changed regarding how patients are listed for transplant, there have not been any more Living Donor-lung transplants (to my knowledge--Please correct me if I'm wrong) since 2004. USC did its final 3 within 1 1/2 months of each other. One of those being me (the 1st), then a young CF woman exactly 2 weeks after, and the third, a young married CF guy. Because our transplants were performed so close together, and since I was in the hospital for 2 1/2 months, our families grew close, and me and the other girl became good friends. They both live in California.