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Lung Transplant Using Nonbeating Heart Donor Works

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March 15, 2001 -- In one of the first transplants to be performed from a donor human whose heart had stopped beating hours before the transplant was performed, Swedish researchers have shown that the procedure is effective and can quickly restore lung function. This procedure could help ease the critical shortage of donor organs worldwide. But the needs of potential transplant recipients must be balanced against the rights of potential donors and their families, say experts.

In the U.S. and many other countries, the hearts of organ donors are usually kept pumping through artificial means after the patient has been declared brain dead, that is, after all brain activity has irreversibly ceased. This is necessary to keep blood (and thus oxygen) flowing through the organs -- kidney, heart, liver, etc. -- before donation. Lungs, however, are unique in that they can be cooled and preserved for up to 12 hours after the heart has stopped beating.

Despite vast improvements in organ preservation and transplant techniques, however, the demand for donor organs still far outpaces the supply. In Sweden, for example, 20% of patients on the waiting list for a lung transplant die before an organ becomes available, says lead author Stig Steen, professor of cardiothoracic surgery at the University of Lund.

But if a method could be found for obtaining lungs from the bodies of people who died from heart disease in addition to those who were maintained on mechanical support after brain death, "there would be many more lungs [available] than there are patients, because on the one hand there are only 100 cases of brain death in Sweden each year, but 90,000 die due to cardiovascular disease. So many thousands of lungs could become available," Steen tells WebMD.

Steen and his colleagues have developed just such a method, which involves cooling the lungs within the body about 1 hour after the donor has died. But because the procedure involves delivering a clot-preventing drug to the body immediately after the patient has died, possibly before the next-of-kin have granted formal consent for organ donation, it raises a host of ethical concerns that need to be addressed by society at large, says Martin Elliott, MD. Elliott, a consultant cardiothoracic surgeon and director of cardiothoracic transplantation at Great Ormond Street Hospital for Children in London, wrote an editorial accompanying the study.

"What that means is, if you're sitting in an ICU somewhere and a patient dies, you have to take some steps on the off chance they might be a donor," Elliott tells WebMD. "But for many people, that's a huge ethical step, because it suggests that you have imposed the moral obligation to go ahead and donate."

To prevent such ethical fires from flaring up in the first place, Steen and colleagues took the extraordinary step of inviting public comment on their proposed technique in a wide-scale information campaign on television and radio and in major newspapers. They also consulted with physicians, nurses, hospital chaplains, and judges. "From this consultation, we learned that any type of surgery on a dead body within 1 hour of death was ethically unsound, but that if topical cooling of the lungs could be accomplished without leaving scars, then the planned procedure ought to be acceptable," the authors write.

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