Surgical advances in donor selection and management for heart and lung transplantation

Purpose of review: The population of patients with end stage heart failure and lung disease is growing, but the number of transplants performed has been limited by an inadequate supply of organs. Attention has focused on liberalizing donor criteria to maximize the number of available organs, and on improving critical care and preservation techniques to optimize their quality. Recent findings: General criteria including age, gender matching, size, cause of death, and infection as well as organ specific criteria like coronary artery disease, smoking history, asthma, and ischemic time have been extended with little impact on short term outcome. Better understanding of the systemic affects of brain death has led to improved donor care and more usable organs. Long-term follow up data on the effects of these changes has become available. This allows further insight into the risk calculations necessary to match extended criteria donors to specific recipients. Summary: Accurate risk assessment of using extended criteria donor organs against the individual's risk of dying on the waiting list is becoming increasingly complex and is essential for achieving successful outcomes in the current environment of thoracic transplantation.