Donor Lung Extraction And Preservation

Currently, the parameters used to assess donor lungs are based on donor history, arterial blood gases, chest-x-ray appearance, bronchoscopic findings, and physical examination of the lung at the time of retrieval.19 Recent evidence suggest that a bolus dose of corticosteroids (methylprednisolone 15 mg/kg) administered do organ donors after brain death declaration can improve Pa02 and increase lung donor recovery.10

The following procurement procedure will allow a single donor to provide thoracic organs for up to three recipients. Both lungs are routinely extracted en block using a procedure described in detail in a previous report.19 After the preliminary evaluation of the chest radiographs and fiberoptic bronchoscopy, the final assessment is made by gross inspection of the lungs once they are exposed by a median sternotomy in conjunction with the midline laparotomy for the extraction of the abdominal organs. The three basic components of the thoracic dissection are:

1. Venous inflow: The intra-pericardial superior and inferior vena cavae (SVC, IVC) are isolated and the SVC is encircled with heavy silk ligatures.

2. Arterial exposure: The ascending aorta and main pulmonary artery (PA) are separated from one another and encircled with umbilical tapes.

3. Airway dissection: The posterior pericardium (between the aorta and SVC) is incised, exposing the distal trachea.

On completion of the thoracic and abdominal dissection, the donor is heparin-ized to permit cannulation, which can be performed by all teams simultaneously, or sequentially if the donor maintains a stable condition. A cardioplegia cannula is inserted into the ascending aorta. A large bore pulmonary flush cannula is then

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