Living lobar transplantation.

Although cadaveric transplantation remains the preferred option for patients who have end-stage lung disease, living lobar transplantation provides organ availability that can be life saving in severely ill pediatric and adult patients who will either die or become unsuitable recipients before a cadaveric organ becomes available. In addition, living lobar transplantation provides acceptable long-term survival when compared with recipients of cadaveric grafts; however, because this procedure presents risks to two healthy donors, appropriate recipient and donor selection and timing of transplantation are critical to minimize the morbidity to the donor and maximize the chance of a successful outcome in the recipient. The results of the authors' experience have demonstrated that the donor procedure is safe, well tolerated physiologically, and that the great majority of donors are extremely satisfied with their decision to donate. Although there have been no deaths in the donor cohort, a risk of death between 0.5% to 1% should be quoted pending further data. These encouraging results are important if this procedure is to be considered as an option at more pulmonary transplant centers in view of the institutional, regional, and intra- and international differences in the philosophical and ethical acceptance of the use of live organ donors for transplantation.