First Canadian live-donor lung transplants performed in Winnipeg
CMAJ 2000;162:1339
Canadian medical history was made in Winnipeg last December with the first lung transplant that used healthy, single lobes from 2 living donors. A second live-donor lung transplant has since been performed by a team headed by Dr. Helmut Unruh, director of the Manitoba Lung Transplant Program at the Health Sciences Centre. The first patient has been discharged, but the second has since died of cardiac complications.
"Many of my colleagues wondered if [the transplant operation] was worth it," Unruh commented. "Does the outcome justify the risk to the donors? With a 5-year survival rate of 60% on lung transplant, does it warrant it? But any transplanted organ [has] a finite lifetime."
Unruh believes the procedure is worth the risk, given the lengthy waiting list for cadaveric donations and the condition of the patients involved. For the donors, the life-long outcome is a reduction of approximately 20% of their lung capacity, perhaps preventing them from marathon running but not restricting them from a generally active life.
Unruh said the procedure itself is similar technically to a cadaveric lung transplant. He said allowance must be made for smaller vessels because the transplanted lobe might not fill the entire thoracic cavity. This is one of the reasons why children and small adults are the primary candidates for live-donor lung transplants. The limited number of small cadaveric lungs available for transplantation also places them in the live-donor recipient category.
Although the procedure remains relatively new — about 60 of the operations have been performed worldwide — Unruh has advised other patients to start looking for possible live donors.
"There is no bank of [living] lung donors so the responsibility for procuring a donor is the patient's or the family's, or a coordinator appointed by them, depending on the complexity," said Unruh. "The hospital can't go and solicit lung donations."
Having live donors has added a new dimension to lung transplantation. Unruh said the team had to consider how to screen donors and consider their motivation. It would be advantageous, he suggested, to learn about psychological considerations in screening live donors.
As Unruh and his team pursue live-donor transplants as an option for some patients, centres in Toronto, Montreal and Vancouver are expected to start performing the procedure. Although Unruh's colleagues across the country are waiting to see the longer-term outcome, families of patients on organ transplant waiting lists may be looking to a new window of opportunity and hope. — Jane Stewart, Winnipeg
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