Assessment, Procurement, and Preservation of the Lungs

Currently, primary graft dysfunction (PGD) is the leading cause of early mortality after lung transplantation. To prevent PGD, the accurate evaluation of lung allografts at the time of procurement along with standardized lung procurement and organ preservation techniques is essential. Donor lung evaluation consists of a combination of the critical analysis of donor past medical history, radiological/laboratory testing, and on-site evaluation. Based on the criteria published by the International Society of Heart and Lung Transplantation (ISHLT), a standard criteria donor (SCD) is defined as the following: Due to the overwhelming mismatch between donor lung availability and patients waitlisted for transplantation, “extended” criteria donor (ECD) lung allografts, defined as having one or more deviations from the SCD criteria, have become more frequently utilized. Therefore, in the setting of ECD, it is imperative to perform a more careful evaluation of donor lung quality and to assess recipient risk factors in order to maintain excellent outcomes following lung transplantation.