32855 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; unilateral

Name of the Procedure:

Backbench Standard Preparation of Cadaver Donor Lung Allograft Prior to Transplantation

Summary

This procedure involves preparing a lung from a deceased donor for transplantation. It includes carefully separating the lung from surrounding tissues to ensure the pulmonary veins, arteries, and bronchus are properly prepared to be connected to the recipient during the transplant.

Purpose

The procedure addresses end-stage lung diseases for which lung transplantation is the most viable treatment. The goal is to ensure the donor lung is ready and in the best possible condition for successful transplantation into the recipient.

Indications

This procedure is indicated for patients who:

• Have severe, irreversible lung disease (e.g., chronic obstructive pulmonary disease, pulmonary fibrosis, cystic fibrosis).
• Meet the criteria for lung transplantation including overall health status and absence of contraindications.

Preparation

• The patient will need to follow pre-surgical instructions including fasting and any necessary medication adjustments.
• Diagnostic tests such as CT scans, blood tests, and pulmonary function tests are conducted to ensure the patient is suitable for the transplant.

Procedure Description

1. The donor lung is isolated from the body in a surgical suite.
2. Surgeons meticulously dissect the lung from surrounding soft tissues, taking special care to prepare:
   • Pulmonary veins and atrium cuff
   • Pulmonary artery
   • Bronchus
3. The lung is then flushed with a preservation solution to maintain viability.
4. Special tools such as surgical scalpels, clamps, and preservation equipment are used.
5. The process is conducted under sterile conditions to minimize infection risk.

Duration

The procedure typically takes 2 to 4 hours, depending on the complexity and condition of the donor lung.

Setting

Performed in a hospital operating room equipped for specialized surgical procedures.

Personnel

• Thoracic surgeons with experience in transplantation
• Surgical nurses
• Anesthesiologists
• Technicians specialized in organ preservation

Risks and Complications

• Common risks: Bleeding, infection, damage to the lung tissue.
• Rare risks: Reaction to preservation solution, issues with lung viability post-preparation.

Benefits

• Increases the likelihood of a successful lung transplant.
• Ensures the donor lung is in optimal condition, maximizing the recipient's chances of recovery and improved lung function.

Recovery

• Following the procedure, the donor lung is maintained in a preservation solution until transplantation.
• The recipient will follow post-transplant care involving immunosuppressive therapy, monitoring for rejection, and regular follow-up appointments.
• General recovery for the recipient can vary, with close monitoring required in the initial weeks to months.

Alternatives

• Use of living donor lobar transplantation if a cadaveric donor is not available.
• Artificial lungs or lung assist devices in severe cases where transplantation is not immediately possible.
• Each alternative comes with different risks and benefits, potentially limited availability, and varying success rates.

Patient Experience

• The donor remains deceased and experiences no sensation.
• The recipient may experience discomfort post-transplant, managed with pain medications and supportive care.
• Gradual improvement in breathing and overall health is expected as the new lung adapts and functions within the recipient’s body.