32856 Backbench standard preparation of cadaver donor lung allograft prior to transplantation, including dissection of allograft from surrounding soft tissues to prepare pulmonary venous/atrial cuff, pulmonary artery, and bronchus; bilateral

Name of the Procedure:

Backbench Standard Preparation of Cadaver Donor Lung Allograft Prior to Transplantation (Bilateral)

Summary

This procedure involves preparing a lung from a deceased donor for transplantation. The preparation includes carefully dissecting the donor's lung from the surrounding soft tissues to ready the pulmonary venous/atrial cuff, pulmonary artery, and bronchus for transplantation into the recipient.

Purpose

The procedure addresses the need for properly prepared donor lungs to ensure successful lung transplantation. The goal is to prepare the donor lung meticulously so that it can function correctly in the recipient, thereby improving respiratory function and quality of life.

Indications

• End-stage lung diseases such as Chronic Obstructive Pulmonary Disease (COPD), Idiopathic Pulmonary Fibrosis, or Cystic Fibrosis.
• Severe, non-reversible lung damage or failure.
• Patients eligible for lung transplantation, typically determined by stringent medical criteria including overall health, lung function, and absence of significant comorbid conditions.

Preparation

• The patient typically needs to fast starting from the night before the transplantation.
• Routine blood tests, imaging studies (such as a chest X-ray or CT scan), and pulmonary function tests are required.
• Pre-operative consultations to adjust any current medications and assess overall health status.

Procedure Description

1. Preparation area and tools: The procedure is performed in a sterile environment with specialized surgical instruments.
2. Dissection: The surgeon begins by dissecting the lung from surrounding soft tissues.
3. Pulmonary Venous/Atrial Cuff Preparation: The pulmonary veins are carefully isolated and the atrial cuff is prepared for connection to the recipient's heart.
4. Pulmonary Artery Preparation: The pulmonary artery is dissected and trimmed for anastomosis.
5. Bronchus Preparation: The bronchus is prepared ensuring it is appropriately sized and shaped for attachment to the recipient's airway.
6. Final Inspection: The team inspects the lung to ensure it is ready for transplantation.

Anesthesia or sedation is not applicable to the donor lung preparation, as the donor is deceased. However, the recipient will be under general anesthesia during the transplantation.

Duration

The preparation of the donor lung typically takes 1 to 2 hours, though this can vary based on individual circumstances.

Setting

The procedure is performed in a hospital's surgical department, typically in a specialized operating room for transplant surgeries.

Personnel

• Transplant Surgeons
• Assistants and Surgical Technologists
• Perfusionists (if required)
• Supporting Staff including nurses

Risks and Complications

Common risks:

• Damage to the allograft during preparation
• Unexpected anatomical variations leading to preparation difficulty

Possible complications:

• Failure of the lung to function in the recipient
• Post-transplant rejection and infection management

Benefits

Proper backbench preparation of the donor lung leads to:

• Increased likelihood of successful transplantation
• Improved lung function and quality of life for the recipient
• Reduced risk of immediate post-transplant complications

Recovery

Since this is a part of the transplantation process, there is no recovery for the donor lung itself. For the recipient, however:

• Intensive monitoring in a critical care unit following transplantation
• Gradual increase in physical activity
• Lifelong follow-up and immunosuppressive therapy to prevent rejection

Alternatives

• Use of other types of donor organs (e.g., living lobar lung donation)
• Non-surgical management for end-stage lung disease, though this may not be effective in severe cases

Patient Experience

During the procedure:

• The donor lung does not involve patient sensations.
• The recipient will be under general anesthesia and will not experience pain during the transplant surgery.

Post-procedure:

• The recipient may experience discomfort and requires pain management.
• Post-surgery care includes hospital stay, breathing exercises, and careful activity monitoring.

Comfort measures include:

• Pain relief medications.
• Respiratory support if needed.
• Continuous care by a dedicated transplant team.