Surgery to transplant a lung lobe from a living donor is offered by very few centres around the world, due to the complex nature of the surgery, and the pre- and post-operative care required, yet this pioneering procedure is available at Harefield Hospital.
Lung transplantation is often the last resort for patients who suffer from end-stage lung disease. A lobe transplant differs from a single or double lung transplant in that it uses lobes from two living donors, rather than a single or double healthy lung from a donor who has been pronounced brain dead.
Harefield Hospital is one of the largest and most experienced centres in the world for heart and lung transplants. The transplant team, led by Mr André Simon, are able to offer living donor lung lobe transplants thanks to their knowledge and expertise.
Two donors each give a lobe
Living donor lung lobe transplants usually require the donors to be close blood relatives. Although in some cases, spouses or close friends may also donate but this needs the prior approval of the Unrelated Live transplant Regulatory authority (ULtRa). It illustrates the lengths that family will go to in hopes of saving the life of a loved one.
As usually two donors are needed to each donate one lobe, the transplant typically involves three operations, one on each of the two donors and one on the recipient.
Once donor suitability is determined based on blood type and lung function capacity, donors are selected for right and left lower lobectomy which is placed into the recipient to take the place of their diseased lungs.
Each lobe expands to fit
The surgery begins with one of the lower lobes being removed from each of the donors, leaving them with four lung lobes. The remaining lung tissue will expand to occupy the space left by the donated lobe.
The recipient will have both of their diseased lungs removed and receives two new lung lobes, one from each donor. While the lung function will not be 100 per cent right away, at two years it should be comparable with those receiving conventional transplant. Two lobes have the ability to provide a near normal lung function.
After the operation, donors are usually up and walking two days later, and can be discharged from hospital about a week later. The recovery time could be over a month.
While donors will experience post-operative pain and will have a chest tube for a short while after the operation, long term effects on donors can be minimal to none. The fact that the donor only has four lung lobes instead of five means they may experience less exercise tolerance for competitive sports, but will be able to live a normal life in other respects.
Donors must have extensive counselling to make sure they understand the risks, both in terms of morbidity and mortality. The risks are small but are spelt out in detail and written information is given to the donor.
Ethics of operating on fit donors
Initially, surgeons found this a difficult operation to contemplate. Surgeons usually operate on sick patients with the hope of making them better. In this situation they are being asked to operate on two fit people, leaving them with four, instead of five, lung lobes, in the hope of saving the life of a critically ill third person.
However, after much thought and consideration, including discussion with the ethics committee, the team at Royal Brompton and Harefield Hospitals thought they no longer had a right to refuse. There was also considerable pressure brought by the relatives of sick patients for this procedure to be made available.
25 years of expertise
The first living lobe transplant for cystic fibrosis in the UK was performed by Professor Sir Magdi Yacoub at Harefield Hospital in July 1995.
As Mr André Simon and his team pursue living donor transplants for patients, it gives a new opportunity of hope for families of patients on waiting lists.
Consultant cardiothoracic surgeon, Director heart and lung transplantation and mechanical circulatory support