title: Pitfalls in donor lung procurements: how should the procedure be taught to transplant trainees?
abstract: OBJECTIVE
  The current trend in lung transplantation has led to liberalized lung donor selection criteria and use of marginal donors, with a corresponding requirement for improved procurement techniques to obtain high-quality donor grafts. Few reports, however, have provided recommendations for successful lung procurement procedures.
  
  
  METHODS
  We retrospectively studied 47 lung procurements performed by the University of Pittsburgh Medical Center team from January 2007 to December 2007. From those findings, we compared outcomes, as well as technical errors encountered, between procurements performed by trainees with limited transplant experience and by experienced transplant surgeons.
  
  
  RESULTS
  Twenty-two of the procurements (47%) were performed by experienced transplant surgeons and 25 (53%) by supervised trainees. Patient characteristics and technical difficulties were comparable between the two groups. The trainees took more time to complete the procedure than did the experienced surgeons, although the difference was not significant. Furthermore, 21 of the cases performed by trainees (84%) had one or more technical errors in the sequential steps of the procurement, including inadequate placement of the perfusion cannula in the main pulmonary artery (60%), insufficient topical cooling (56%), and inadequate timing of the start of pulmonary artery perfusion (44%).
  
  
  CONCLUSIONS
  Donor lung procurements performed by beginners with limited transplant experience included frequent technical errors with regard to adequate graft preservation, which may lead to serious complications after transplant. Sequential steps in lung procurement techniques and better understanding of organ preservation should be an integral part of a lung transplant training program.
authors.affiliation: Cardiopulmonary Transplantation, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. shigemura@thoracic.med.osaka-u.ac.jp
authors.forename: Norihisa
authors.initials: N
authors.lastname: Shigemura
authors.forename: Jay
authors.initials: J
authors.lastname: Bhama
authors.forename: Duc
authors.initials: D
authors.lastname: Nguyen
authors.forename: Jnanesh
authors.initials: J
authors.lastname: Thacker
authors.forename: Christian
authors.initials: C
authors.lastname: Bermudez
authors.forename: Yoshiya
authors.initials: Y
authors.lastname: Toyoda
mesh_terms: D000328:Adult; D004521:Educational Measurement; D005257:Fellowships and Scholarships; D005260:Female; D006801:Humans; D016040:Lung Transplantation; D008297:Male; D009926:Organ Preservation / Q000592:standards; D013903:Thoracic Surgery / Q000193:education*; D020858:Tissue and Organ Harvesting / Q000193:education* / Q000592:standards