Psychosocial and ethical issues in surgical approaches to end-stage lung disease.

Heart-lung transplantation became a treatment option for end-stage lung parenchymal and vascular disease in 1981. Although many advances have occurred in the field surrounding donor selection, allograft preservation, surgical techniques, immunosuppression, and rejection and infection treatments, a shortage of cadaveric donors continues. This results in increased waiting times for the candidates, which in itself introduces an array of physical and psychological issues that must be addressed before transplant. This article examines the psychological factors evident in this period. In addition, ethical issues related to the allocation system and their impact on organ availability and, therefore, the time spent waiting for a lung transplant are presented.