Present state of nonheart-beating lung donation.
OBJECTIVE
Indications for lung transplantation have increased through the years, and currently we have to face a lack of grafts to attend this growing demand with the subsequent increase in waiting-list deaths. Several strategies have been proposed to solve this challenging problem (living-lobe donors, extended donors, size-reduced lung grafts and so on), the use of nonheart-beating donors (NHBDs) being the most promising of them.


RESULTS
The last experimental works concerning NHBDs have focused on the improvement of graft preservation in order to minimize warm ischemic injury and the capacity of noninvasive parameters in bronchial lavage to predict good function after implantation. There have also been several reports on the clinical use of controlled and uncontrolled NHBDs with excellent results.


CONCLUSIONS
Several methods have been effective in protecting these grafts from ischemic damage. Functional predictors will be very useful in the near future allowing us to know in a simple and noninvasive way which grafts are suitable for transplantation. Definitely, NHBDs for lung transplantation are no more a promising source of grafts but a real one, with encouraging short-term and mid-term results.
de Antonio
David Gomez
DG
Thoracic Surgery and Lung Transplantation Department, Hospital Universitario Puerta de Hierro, Madrid, Spain.
de Ugarte
Andres Varela
AV
D006801:Humans; D016040:Lung Transplantation; D009926:Organ Preservation / Q000379:methods; D015427:Reperfusion Injury / Q000517:prevention & control; D014022:Tissue Survival; D020858:Tissue and Organ Harvesting; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome; D014850:Waiting Lists