Transplantation of lungs from a non-heart-beating donor

Background In animals, we have previously done successful lung transplantat ions using organs from non-heart-beating donors. We have also developed an ex-vivo system of assessing the function of such organs before transplantat ion. The next stage was to try the technique in human beings. Bearing in mi nd the sensitive ethical issues involved, our first aim was to find out wha t procedures would be acceptable, and to use the results to guide a clinica l lung transplantation from a non-heart-beating donor. Methods 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 i nfarction in a cardiac intensive-care unit after failed cardiopulmonary res uscitation. The next of kin gave permission to cool the lungs within the in tact body, and intrapleural cooling was started 65 min after death. Blood s amples were sent for virological testing and cross matching. The next of ki n then had time to be alone with the deceased. After 3 h, the body was tran sported to the operating theatre and the heart-lung block removed. The lung s were assessed ex vivo, and the body was transported to the pathology depa rtment for necropsy. Results No contraindications to transplantation were found, and the right l ung was transplanted successfully into a 54-year-old woman with chronic obs tructive pulmonary disease. The donor lung showed excellent function only 5 min after reperfusion and ventilation, and during the first 5 months of fo llow-up, the function of the transplanted lung has been good. Interpretation About half the deaths in Sweden are caused by cardiac and ce rebrovascular disease. This group could be a potential source of lung donor s. When all hospitals and ambulance personnel in Sweden have received train ing in non-heart-beating lung donation, we hope that there will be enough d onor lungs of good quality for all patients needing a lung transplant.