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Abstract
In animals, we have previously done successful lung transplantations using organs
from non-heart-beating donors. We have also developed an ex-vivo system of assessing
the function of such organs before transplantation. The next stage was to try the
technique in human beings. Bearing in mind the sensitive ethical issues involved,
our first aim was to find out what procedures would be acceptable, and to use the
results to guide a clinical lung transplantation from a non-heart-beating donor.
The ethical acceptability of the study was gauged from the results of a broad information
programme directed at the general public in Sweden, and from discussions with professionals
including doctors, nurses, hospital chaplains, and judges. The donor was a patient
dying of acute myocardial infarction in a cardiac intensive-care unit after failed
cardiopulmonary resuscitation. The next of kin gave permission to cool the lungs within
the intact body, and intrapleural cooling was started 65 min after death. Blood samples
were sent for virological testing and cross matching. The next of kin then had time
to be alone with the deceased. After 3 h, the body was transported to the operating
theatre and the heart-lung block removed. The lungs were assessed ex vivo, and the
body was transported to the pathology department for necropsy.
No contraindications to transplantation were found, and the right lung was transplanted
successfully into a 54-year-old woman with chronic obstructive pulmonary disease.
The donor lung showed excellent function only 5 min after reperfusion and ventilation,
and during the first 5 months of follow-up, the function of the transplanted lung
has been good.
About half the deaths in Sweden are caused by cardiac and cerebrovascular disease.
This group could be a potential source of lung donors. When all hospitals and ambulance
personnel in Sweden have received training in non-heart-beating lung donation, we
hope that there will be enough donor lungs of good quality for all patients needing
a lung transplant.