Ann Thorac Surg 2003;76:252
© 2003 The Society of Thoracic Surgeons
Original article: general thoracic
Invited commentary
Joshua R. Sonett, MDa
a Columbia Presbyterian Hospital, 161 Fort Washington Avenue, Room 310, New York, NY 10032, USA
e-mail: js2106{at}columbia.edu
Steen and colleagues present a very well documented animal study investigating their group’s methods to functionally assess the viability of lungs donated by nonheartbeating donors. The rigorous and meticulous protocol presented and the group’s successful use of this technique in a human case support the continued study and possible wide application of these protocols. However, the application of ex vivo testing and preservation of nonheartbeating donor lungs to other institutions and the ability of other institutions to support these services may prove to be more challenging. Many practical obstacles to the wide use of this type of donation may limit the ability of these techniques to significantly close the widening gap between organs donated and the numbers of patients awaiting lung transplantation.
However, lessons already learned in their clinical and experimental studies could immediately improve the ability of multiple institutions to maximize the use of heartbeating donors. The use of lungs that in the past have been considered unacceptable for lung transplantation could be extended if previously defined "poor" quality lungs are found safe for transplant. Many groups are now pushing the previous bounds of the standard criteria of assessing lungs for donation, and the use of these so-called marginal donors could have an immediate effect on alleviating the donor shortfall. The use of such lungs can now be considered, as techniques of lung preservation and controlled leukocyte lung reperfusion appear to be decreasing the immediate dangers of sig-nificant acute reperfusion injury. The possible addition of other techniques, such as topical ECMO for extended preservation and decreased lung inflation during storage (semisolid storage), could further enhance both the supply and function of donor lungs. Presently a working group, identified with the help of the International Society for Heart and Lung Transplant, is developing a lung donor quality score to quantify many aspects of donor lungs. With the cooperative input of multiple transplant centers, this prospective database will be correlated with outcome results and may guide the transplant community to better utilize the potential supply.
The application of ex vivo lung assessment has the potential both to expand the use of heartbeating donors and to develop the practice of lung donation from nonheartbeating donors. Cooperative multi-institutional work to enhance the utilization of heartbeating donors and to further investigate the use of nonheartbeating donors are crucial for the continued growth and development of lung transplantation. To this end, the pioneering work of Dr Steen and his colleagues is an important contribution.
