Choice Of Procedure

The type of lung transplant procedure to be performed depends primarily upon the clinical condition responsible for the end-stage pulmonary process. Both single lung transplantation (SLT) and BLT have been used to treat COPD.13-15 Patients with CF or other diffuse septic pulmonary processes must undergo BLT to eliminate the risk of transmitting infection from the remaining native lung to the newly transplanted pulmonary allograft.16 Single lung transplantation is the procedure of choice in patients with IPF since the diminished compliance and increased vascular resistance of the native lung will lead to preferential ventilation and perfusion of the transplanted lung.17 Bilateral lung transplantation may also be offered to patients with IPF, especially in very young or large individuals. For patients with PPH, heart-lung transplantation has traditionally been the procedure of choice. However, both SLT and BLT lead to satisfactory recovery of right ventricular function in these patients. Recent evidence indicates that for patients with ES

Table 12.5. General guidelines for managing the multiple organ donor

• Pulmonary capillary wedge pressure <12 mmHg

• Judicious fluid replacement

- Replace electrolyte losses

- Maintain urine output at 1 to 2 ml/kg/hr

- Use DDAVP for treatment of documented diabetes insipidus

• Treat hypotension with a combination of fluid replacement and dopamine infusion up to 10 mcg/kg/min

• Maintain normothermia

• Maintain PEEP at 5 cm H20 and PaO2 >100 mmHg on lowest FIO2

• Strict pulmonary toilet

• Measure arterial blood gases every 2 hours

• Elevate head of bed if possible secondary to a ventricular septal defect, heart-lung transplantation should be considered the procedure of choice.18

According to the most recent Registry report, the majority of SLT's have been performed for either COPD (54.4%) or IPF (23.8%), and most of the BLT's have been performed for either CF (33%) or COPD (22.5%).1

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