Professional Documents
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Policy:
our programme has been to limit LDLLT to critically ill patients
who are unlikely to survive the long wait for cadaveric lungs.
Criteria of the donor:
Investigations :
ABO blood group compatibility with the potential recipient.
Routine labs including liver functions, kidney functions,
bleeding profile and complete blood count.
Cultures to exclude current and previous bacterial, viral,
and fungal infections( blood, sputum, urine, stool).
Serologic tests for hepatitis A, B, and C, human
immunodeficiency virus, varicella, Epstein-Barr virus, herpes
simplex virus, and cytomegalovirus
Room air arterial blood gas and spirometry.
Ventilation-perfusion (VQ) scan.
Computed tomography (CT) scan of the chest to exclude
pulmonary pathology and to allow volumetric assessment (
3D CT volumetry).
Determination of the cytomegalovirus status was performed
to predict which patients would need prophylactic antiviral
therapy. Cytomegalovirus mismatch was not used as an
exclusion to transplantation.
Size matching:
Functional and anatomical size matching is very important. given
that the right lower lobe consists of 5 segments, the left lower lobe
of 4, and the whole lung of 19, total forced vital capacity (FVC) of
the 2 grafts was estimated by the following equation.
Eithical issues:
In this situation they are being asked to operate on two fit people,
leaving them with four, instead of five, lung lobes, in the hope of
saving the life of a critically ill third person.
A donor with four lung lobes instead of five lung lobes will have
less exercise tolerance for competitive sports, but will be able to
live a normal life in all other respects. The reason why the
individual wishes to donate must be explored. No money, or other
reward, must be involved. The reason given is usually to see a
loved one survive
Potential donors were interviewed by 3 physicians with an
observer to safeguard against coercion and to ensure donor
comprehension of the procedure. The interview was performed at
least 3 times to provide potential donors multiple opportunities to
question, reconsider, or withdraw as a donor.