Living lobar lung transplantation was developed as an alternative to cadaver lung transplantation because of the continuing shortage of acceptable donor organs.1,2 In living lobar lung transplantation, two healthy donors are selected—one to undergo removal of the right lower lobe and the other removal of the left lower lobe. These lobes then are implanted in the recipient in place of whole right and left lungs. This technique has proved to be beneficial to a group of patients who otherwise would have succumbed to disease while awaiting lungs from a conventional deceased donor.3
Living lobar lung transplant candidates should meet the standard criteria for deceased donor lung transplantation and be listed on the Organ Procurement and Transplantation Network lung transplantation waiting list.4 The expectation for potential recipients should be that they will either die before a deceased (cadaver) donor lung becomes available or become too ill to undergo any sort of organ transplant procedure. In the United States, cystic fibrosis is the most common indication for living lobar lung transplantation. However, other indications include primary pulmonary hypertension, pulmonary fibrosis, bronchopulmonary dysplasia, obliterative bronchiolitis, lymphangioleiomyomatosis, and idiopathic interstitial pneumonia.2,5
The goals of donor selection are to identify donors with excellent health, adequate pulmonary reserve for lobar donation, an emotional attachment to the recipient, and a willingness to accept the risks of donation without coercion. Our criteria for donation also include age between 18 and 55 years, no history of thoracic procedures on the side to be donated, and excellent general health. Donors taller than the recipient are favored over donors of the same or lesser height because they have the potential to provide larger lobes. Initially, only the mother and father of the recipient were considered as donors; however, lobes from siblings, extended family members, and unrelated individuals who can demonstrate an emotional attachment to the recipient are also presently considered. A psychosocial interview is conducted. Potential donors are interviewed both separately and with the potential recipient's family to ascertain interpersonal dynamics. Elements of the interview include the motivation to donate, pain tolerance, feelings regarding donation should the recipient expire, and the ability of the potential donor to be separated from family and career obligations. Since an element of coercion always can exist between a potential donor and the recipient and/or the recipient's family, any potential donor who discloses that he or she feels any pressure to donate after careful consultation and explanation of the procedure is denied for unspecified reasons, thus preventing untoward feelings between the family, recipient, and potential donor.
After the psychosocial evaluation, suitable potential donors undergo blood typing for compatibility as well as chest radiography and spirometry to assess lung size and function. This preliminary screening reduces costs because it allows for the evaluation of only a limited number of potential donors. A more thorough medical workup, including routine transplant serologies (i.e., HIV, VDRL, cytomegalovirus, Epstein-Barr virus, and ...