Living-Donor Lung Transplantation: Indications and Limitations

Living-donor lobar lung transplantation (LDLLT) is a viable option for individuals who cannot endure the extensive wait times due to an inadequate number of available brain-dead donors. A typical LDLLT operation involves the harvesting of the right and left lower lobes from two healthy donors that are subsequently implanted in a recipient after right and left pneumonectomies, with the use of cardiopulmonary bypass. As a result of ethical concerns, we limit living donors to immediate family members (such as spouses or relatives within the third degree). It is crucial to verify that potential donors are capable and willing of donating without any psychologic coercion from others. LDLLT was initially recommended for children and smaller adults, such as those with cystic fibrosisCystic fibrosis, due to the implantation of only two lobes. However, there has been an acceptance of various lung diseases as potential indications for LDLLT including restrictive, obstructive, infectious, and vascular lung diseases. In relation to the issue of size matching, functional size matching involving the measurement of donor pulmonary function and anatomical size matching utilizing 3D-CT volumetry prove to be highly useful. For critically ill patients who cannot afford a prolonged wait for brain-dead donor lungs, LDLLT is a feasible alternative. We have effectively devised a range of surgical strategies that address size disparities, yielding favorable results.