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Norihisa Shigemura
Jay Bhama
Duc Nguyen
Jnanesh Thacker
Christian Bermudez
Yoshiya Toyoda
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Right arrow Lung - transplantation

J Thorac Cardiovasc Surg 2009;138:486-490
© 2009 The American Association for Thoracic Surgery

Cardiothoracic Transplantation

Pitfalls in donor lung procurements: How should the procedure be taught to transplant trainees?

Norihisa Shigemura, MD*, Jay Bhama, MD, Duc Nguyen, MD, Jnanesh Thacker, MD, Christian Bermudez, MD, Yoshiya Toyoda, MD

Cardiopulmonary Transplantation, University of Pittsburgh Medical Center, Pittsburgh, Pa

Received for publication January 9, 2009; revisions received March 16, 2009; accepted for publication April 1, 2009.

* Address for reprints: Norihisa Shigemura, MD, PhD, Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, 2-2 (L5) Yamadaoka, Suita-City, Osaka, 565-0871 Japan. (Email: shigemura{at}thoracic.med.osaka-u.ac.jp).

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%).

Conclusion: 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.

Abbreviation and Acronym PGD = primary graft dysfunction






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